Uric acid-to-lymphocyte ratio as a predictor of incident heart failure in community-dwelling older adults: an exploratory historical cohort study in primary care

Background The uric acid-to-lymphocyte ratio (UALR) is an inexpensive hemogram-derived index whose value for predicting incident heart failure (HF) in older primary care patients is unknown.Materials and Methods In a historical cohort of 310 community-dwelling adults aged 70–85 years followed for 5 years, baseline UALR was compared with the monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and platelet-to-lymphocyte ratio (PLR) as predictors of incident HF (n = 25, 8.1%), defined by WHO clinical criteria. Patients who died during follow-up were excluded by design, which may attenuate the observed association.Results UALR showed the best individual discriminative performance (OR = 1.424, 95% CI: 1.117–1.815; AUC = 0.697) and, after Benjamini – Hochberg correction, was superior to PLR but statistically equivalent to MLR and SII. In nested models, the ratio retained a nominal signal over its components (likelihood ratio test p = 0.016), independent of renal function. Cox regression with bootstrap internal validation yielded a corrected Harrell’s C of 0.843; log-rank by UALR tertiles p < 0.0001.Conclusions In this exploratory cohort, UALR was associated with incident HF, comparable to MLR and SII and superior to PLR. These findings are hypothesis-generating; the limited event count, historical design, and absence of external validation preclude clinical application.