Journal Article

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

Okada, Katsuki, Sato, Taiki, Yano, Masamichi, Sakamoto, Daisuke, Hayashi, Takaharu, Sotomi, Yohei, Yasumura, Yoshio, Nakatani, Daisaku, Hikoso, Shungo, Seo, Masahiro, Kida, Hirota, Kitamura, Tetsuhisa, Nakagawa, Yusuke, Nakagawa, Akito, Yamada, Takahisa, Sunaga, Akihiro, Sakata, Yasushi, Matsuoka, Yuki, Tamaki, Shunsuke

2025

Overview

Aims 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). Methods 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. Results 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]. Conclusions Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients. ALI might complement existing risk indices for prognostic assessment. The advanced lung cancer inflammation index (ALI) is an integrated marker of inflammation and nutritional status, calculated by body mass index × serum albumin / neutrophil‐to‐lymphocyte ratio. Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients.

• Publisher: Oxford University Press,Wiley
• Subject: advanced lung cancer inflammation index / Aged / Aged, 80 and over / Body mass index / Ejection fraction / Female / Follow-Up Studies / Frailty / Heart failure / Heart Failure - complications / Heart Failure - diagnosis / Heart Failure - mortality / Heart Failure - physiopathology / Hemoglobin / HFpEF / Humans / Inflammation / Inflammation - etiology / Lung cancer / Lung Neoplasms - blood / Lung Neoplasms - complications / Lung Neoplasms - diagnosis / Male / Malnutrition / Medical prognosis / Missing data / Mortality / nutrition / Nutritional Status / Observational studies / Patients / Peptides / Prognosis / Prospective Studies / Proteins / Stroke Volume - physiology / Ventricular Function, Left - physiology