Prognostic utility of advanced lung cancer inflammation index in heart failure with preserved ejection fraction

Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). As a marker integrating inflammation and nutritional status, the advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil-to-lymphocyte ratio, has been developed for the prognosis of several diseases including HF. The aim of this study is to investigate the prognostic value of ALI in elderly multimorbid HF patients with HF with preserved ejection fraction (HFpEF).

The study utilized data from the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF). Patients with acute decompensated HF and left ventricular ejection fraction ≥50% were included. ALI levels were calculated from discharge data. The primary endpoint was all-cause death.

A total of 1238 patients [83 (77, 87) years, 555 (45%) male] were enrolled, with 1121 analysed for prognostic value of ALI. In the multivariable Cox model, ALI was significantly associated with the primary endpoint [adjusted hazard ratio (HR) for log-transformed ALI: 0.50, 95% confidence interval (CI): 0.34-0.75, P = 0.001]. ALI appears to enhance the prognostic value of the MAGGIC risk score [net reclassification improvement (NRI) = 46% (95% CI: 28%-65%), P < 0.001; integrated discrimination improvement (IDI) = 4.6% (95% CI: 2.8%-6.5%), P < 0.001], the geriatric nutritional risk index [NRI = 16% (95% CI: -3% to 35%), P = 0.103; IDI = 2.0% (95% CI: 0.8%-3.1%), P < 0.001] and C-reactive protein [NRI = 39% (95% CI: 20%-58%), P < 0.001; IDI = 4.8% (95% CI: 2.9%-6.6%), P < 0.001].

Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients. ALI might complement existing risk indices for prognostic assessment.