Inflammatory and immune-nutritional indices as prognostic markers of mortality after cardiac procedures: evidence from MIMIC-IV

Inflammation-based hematologic indices derived from routine preoperative labs, Hemoglobin-Albumin-Lymphocyte-Platelet (HALP), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), red blood cell distribution width-to-albumin ratio (RAR), and Systemic Inflammation Response Index (SIRI), capture physiologic reserve and immune activation. Their peri-procedural prognostic role across contemporary cardiac interventions, however, remains incompletely defined. We performed a retrospective MIMIC-IV cohort study of open or percutaneous cardiac procedures. HALP, PLR, NLR, SII, SIRI, and RAR were quality-controlled, recalculated, and modeled on the log2 scale. Cox models estimated associations with 90-day and 1-year mortality; spline, strict-preoperative, threshold, and incremental-performance analyses were performed. The cohort included 14,566 cardiac-procedure records. After adjustment, RAR, NLR, SIRI, and SII were associated with higher 90-day and 1-year mortality, whereas HALP showed inverse associations and PLR was less consistent. Strict-preoperative analyses supported RAR, NLR, and SIRI. Spline analyses suggested graded nonlinear risk, and RAR provided the largest modest incremental performance gain. In patients undergoing cardiac procedures, inflammatory and immune-nutritional indices showed clinically coherent associations with mortality. RAR, NLR, and SIRI were the most consistent adverse markers, while HALP was protective. These indices provide modest adjunctive prognostic information and warrant prospective validation.