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The following is a summary of “Nonlinear correlation of neutrophil-lymphocyte ratio on 1-year mortality risk in patients with severe acute heart failure,” published in the April 2025 issue of the BMC Cardiovascular Disorders by Deng et al. 

This retrospective cohort study aimed to investigate the association between the neutrophil-lymphocyte ratio (NLR) and the 1-year mortality risk in patients with acute heart failure (AHF) admitted to the ICU.

A total of 1,176 patients diagnosed with AHF were included in this analysis, using data from the MIMIC-IV database. Cox regression models were employed to examine the relationship between NLR and 1-year mortality risk, adjusting for relevant confounders. The study also explored nonlinear associations and determined optimal NLR cutoff values through restricted cubic splines. Propensity score matching was utilized to mitigate imbalances in baseline characteristics between groups. To validate the NLR threshold, Kaplan-Meier survival analysis was conducted, and the receiver operating characteristic curve was used to assess the diagnostic performance of NLR in predicting long-term outcomes. Subgroup analyses were performed to evaluate the robustness of the NLR association in different patient populations.

The results revealed a significant association between NLR and 1-year mortality. The lowest mortality rate was observed in the lower tertile NLR group (< 5.43), while the highest mortality rate occurred in the upper tertile group (> 13.53), with a trend indicating increasing risk with higher NLR (P for trend < 0.001). A nonlinear relationship between NLR and mortality was identified (P for non-linearity = 0.0075), with a marked increase in mortality risk when NLR exceeded 11.11. The area under the ROC curve (AUC) for NLR predicting 1-year mortality was 0.579 (95% [CI]: 0.542–0.617), indicating moderate diagnostic accuracy. Although the NLR was not significantly associated with long-term outcomes in most subgroups, the association was notably stronger in patients with acute heart failure (AHF) who did not have concurrent sepsis.

In conclusion, an elevated NLR, reflecting increased systemic inflammation, was found to be independently associated with a higher risk of 1-year mortality in ICU patients with AHF. This marker could provide valuable prognostic information for identifying high-risk patients and guiding clinical decision-making.

Source: bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-025-04734-4