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Published on: January 28, 2020
Prognostic value of 9 immune-inflammatory markers for patients with dilated cardiomyopathy: A retrospective study
Rong Chen1, Dilare Adi2,3, Munawaer Keremu3,2
1Sinopharm Dongfeng Huaguo Hospital, Shiyan, Hubei, 442000, China.
Insights
Immune-inflammatory markers from blood cell counts, including neutrophil-to-lymphocyte ratio (NLR), predict mortality in dilated cardiomyopathy (DCM) patients. Combining these markers with the MAGGIC score improves prognostic accuracy for DCM.
Area of Science:
- Cardiology
- Immunology
- Hematology
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Prognostic markers for DCM are crucial for patient management.
- Immune-inflammatory processes play a role in DCM progression.
Purpose of the Study:
- To evaluate the prognostic value of nine immune-inflammatory markers derived from blood cell counts in DCM patients.
- To assess the association of these markers with 3-year all-cause mortality risk.
- To determine if these markers can improve the predictive accuracy of existing risk scores.
Main Methods:
- Retrospective analysis of clinical data from 953 DCM patients.
- Calculation of inflammatory biomarkers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SIRI), and others.
- Statistical analyses included logistic regression, ROC curves, RCS curves, NRI, and IDI to assess mortality risk and predictive enhancement of the MAGGIC score.
Main Results:
- Elevated levels of NLR, PLR, SIRI, and other markers were significant risk factors for 3-year all-cause mortality in DCM.
- NLR, PLR, SIRI, and SII demonstrated good predictive capability (AUC > 0.70).
- Integration of NLR, PLR, SIRI, and SII with the MAGGIC score significantly enhanced its prognostic accuracy.
Conclusions:
- Immune-inflammatory indices derived from blood cell counts are strongly associated with 3-year mortality in DCM.
- The combination of MAGGIC score with NLR, PLR, SIRI, and SII offers a more precise prediction of DCM prognosis.
- These findings suggest a potential role for simple blood-based markers in risk stratification for DCM patients.
Objective:
The study aimed to evaluate the prognostic value of 9 immune-inflammatory markers based on blood cell counts in patients with dilated cardiomyopathy (DCM).
Methods:
A total of 953 DCM patients from the First Affiliated Hospital of Xinjiang Medical University from 2017 to 2021 were selected. Clinical data and test results were collected for retrospective analysis to assess the relationship between various combinations of inflammatory biomarkers derived from neutrophil count, lymphocyte count, monocyte count, and platelet count with the 3-year all-cause mortality risk of DCM. Logistic regression, receiver operating characteristic curve analysis (ROC), restricted cubic spline (RCS) curve analysis were used to evaluate the association between different inflammatory markers and survival outcomes. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were employed to assess the enhancement of each inflammatory index on the Meta-Analysis Global Group in Chronic Heart Failure Risk Score (MAGGIC).
Results:
A total of 105 patients (11.02%) with DCM experienced all-cause mortality within 3 years. Multivariate logistic regression analysis suggested that NM (OR: 1.18, 95% CI: 1.05 ∼ 1.33, P = 0.005), NP (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P < 0.001), MP (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P = 0.004), NLR (OR: 1.44, 95% CI: 1.29 ∼ 1.60, P < 0.001), MLR (OR: 14.58, 95% CI: 5.30 ∼ 40.09, P < 0.001), PLR (OR: 1.01, 95% CI: 1.01-1.02, P < 0.001), SIRI (OR: 1.46, 95% CI: 1.29 ∼ 1.66, P < 0.001) and SII (OR: 1.00, 95% CI: 1.00-1.00, P < 0.001), AIRI (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P < 0.001) were important risk factors for all-cause mortality in DCM. NLR, PLR, SII, SIRI and AIRI showed good predictive capability (AUC all >0.70), and RCS curve analysis indicated an overall upward trend in mortality risk with increasing NLR, PLR, SII, SIRI, and AIRI (P < 0.05). Incorporating NLR, PLR, SIRI, SII, and AIRI into the MAGGIC score substantially enhanced its predictive capacity (P < 0.05), as evidenced by notable increases in NRI and IDI levels (P < 0.05).
Conclusion:
The immune-inflammation indices derived from blood cell counts were closely linked to the 3-year all-cause mortality risk in patients with DCM. The integration of MAGGIC with NLR, PLR, SIRI, SII, and AIRI provides a more precise prediction of DCM prognosis.
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