Prognostic value of advanced lung cancer inflammation index in heart failure patients: A comprehensive analysis

The prognosis of heart failure (HF) is closely linked to inflammation and nutritional status. The advanced lung cancer inflammation index (ALI) is a composite indicator consisting of several parameters used to assess inflammation and nutritional status. Our study aimed to investigate the prognostic value of ALI in HF patients.

The data from Study 1, which included 1359 HF patients, were extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning the years 1999 to 2018. Study 2 analysed data from patients with HF who underwent cardiac magnetic resonance imaging examinations from 2020 to 2023. Kaplan-Meier curve analysis, Cox proportional hazard model, time-dependent receiver operating characteristic (ROC) curve and restricted cubic spline (RCS) were used to evaluate the relationship between ALI and long-term prognosis of patients with HF in Study 1. Logistic regression analysis was used to evaluate the correlation between ALI and left ventricular reverse remodelling, and RCS was used to determine any dose-response relationship. Spearman correlation was used to evaluate the relationship between ALI and indicators of cardiac structural changes.

Study 1 found that the average age of the patients was 68 years [inter-quartile range (IQR) 58-76], the proportion of males was 54.3%, and there were 699 all-cause mortality and 293 cardiovascular mortality cases. After adjusted by multivariable Cox regression analysis, elevated ALI levels were significantly associated with increased risks of all-cause [hazard ratio (HR) = 0.58, 95% confidence interval (CI) = 0.42-0.79, P < 0.001] and cardiovascular mortality (HR = 0.61, 95% CI = 0.38-0.97, P = 0.036) in patients with HF. A linear negative correlation was observed between ALI and both all-cause (P = 0.0011 and P < 0.001, P for nonlinear = 0.3993) and cardiovascular mortality (P = 0.0011, P for nonlinear = 0.5198). Time-dependent ROC curves showed the predictive value of ALI for all-cause mortality [area under the curve (AUC) = 0.678 in 3 years, AUC = 0.674 in 5 years and AUC = 0.683 in 10 years] and cardiovascular mortality (AUC = 0.694 in 3 years, AUC = 0.685 in 5 years and AUC = 0.697 in 10 years). Study 2 included 79 patients; the average age of the patients was 44 years (IQR 35-55); and the proportion of males was 74.7%. Adjusted multivariable logistic regression analysis indicated that high ALI levels were associated with left ventricular reverse remodelling (LVRR) in patients with HF following discharge from the hospital [odds ratio (OR) = 3.16, 95% CI = 1.06-10.8, P = 0.049]. Spearman analysis revealed a correlation between ALI and extracellular volume (ECV) (r = -0.25, P = 0.023).

ALI is associated with all-cause and cardiovascular mortality risk and structural changes in the heart in patients with HF.