Immune-Inflammatory markers and heart failure incidence and mortality: a population-based longitudinal study

Inflammation is a crucial pathophysiological driver contributing to the initiation and perpetuation of heart failure (HF). This study conducted a rigorous comparison among six immune-inflammatory indices to evaluate their predictive role for HF incidence and subsequent mortality.

We analyzed data from 415,263 participants free of HF and 1,952 patients with established HF from the UK Biobank. The markers assessed were the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), inflammatory burden index (IBI), C-reactive protein-albumin-lymphocyte (CALLY) index, and neutrophil-to-lymphocyte ratio (NLR). The outcomes were incident HF and all-cause mortality among HF patients.

Elevated levels of SII, SIRI, AISI, IBI, and NLR showed significant, dose-response relationships with an enhanced likelihood of HF events. The IBI demonstrated the strongest association, with participants in the highest quintile having an 86% higher risk of HF than those in the lowest quintile (HR 1.86, 95% CI: 1.75-1.97). Conversely, a higher CALLY was associated with a lower risk of HF (HR for Q5 vs. Q1: 0.56, 95% CI: 0.53-0.60). Among HF patients, SIRI, AISI, IBI, and NLR had a positive correlation with all-cause mortality, whereas the CALLY was associated with improved survival (HR 0.81, 95% CI: 0.70-0.94). ROC analyses confirmed that IBI provided the superior predictive accuracy for both incident HF and mortality.

Immune-inflammatory markers are significant predictors of HF incidence and prognosis. The IBI emerged as the most robust biomarker, underscoring its utility for risk stratification in primary and secondary HF prevention.