Inflammation-Based Scores as a Common Tool for Prognostic Assessment in Heart Failure or Cancer

Area of Science:

• Cardiovascular Medicine
• Oncology
• Inflammation Biomarkers

Background:

• Inflammation-based scores are established prognostic tools in cancer and are increasingly evaluated in cardiovascular diseases, including heart failure.
• Heart failure with reduced ejection fraction (HFrEF) is a complex condition where inflammatory processes play a significant role.
• Understanding shared inflammatory pathways between HFrEF and cancer may offer novel insights into disease progression and outcomes.

Purpose of the Study:

• To investigate the association of established inflammation-based scores with disease severity in patients with stable HFrEF.
• To evaluate the impact of these scores on overall survival in HFrEF patients.
• To compare these findings with a cohort of treatment-naïve cancer patients to identify similarities and differences in prognostic value.

Main Methods:

• Prospective enrollment of 443 HFrEF patients and 375 cancer patients between 2011 and 2017.
• Calculation of neutrophil-to-lymphocyte-ratio (NLR), monocyte-to-lymphocyte-ratio (MLR), platelet-to-lymphocyte-ratio (PLR), and prognostic nutritional index (PNI) at baseline.
• Statistical analysis including association with disease severity markers (NT-proBNP, NYHA class, tumor stage) and overall survival, with interaction analysis between disease groups.

Main Results:

• All inflammation scores (NLR, MLR, PLR, PNI) strongly correlated with disease severity (NT-proBNP, NYHA class) in HFrEF patients (p ≤ 0.001).
• In cancer patients, only PNI showed a significant association with tumor stage (p = 0.035).
• All scores were significantly associated with all-cause mortality in both HFrEF and cancer cohorts (p ≤ 0.014). Kaplan-Meier analysis confirmed prognostic power (log-rank p ≤ 0.026).
• A stronger increase in mortality risk per score increment was observed in HFrEF compared to cancer for PNI (p_interaction = 0.013) and PLR (p_interaction = 0.005).

Conclusions:

• Inflammation-based scores (NLR, MLR, PLR, PNI) are valuable indicators of disease severity and survival in HFrEF, mirroring their utility in cancer.
• The prognostic impact of PNI and PLR on mortality risk appears more pronounced in HFrEF than in malignant diseases.
• These findings highlight the shared role of inflammation in HFrEF and cancer, suggesting potential for unified therapeutic strategies targeting inflammatory pathways.