Prognostic Value of Systemic Inflammatory Indices in Hospitalized Patients with HFrEF: A Multicenter Retrospective Cohort Study.

OBJECTIVE: This study sought to examine the associations between four inflammatory biomarkers and 1-year adverse cardiovascular outcomes among hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and to compare their prognostic performance. METHODS: A multicenter retrospective cohort study was conducted involving 1814 hospitalized patients with HFrEF (LVEF <40%). Four inflammation-derived biomarkers were derived from standard blood test results. The relationships between these biomarkers and the 1-year incidence of adverse cardiovascular outcomes were analyzed using Cox proportional hazards regression and restricted cubic spline (RCS) modeling. Event-free survival across biomarker tertiles was compared via Kaplan-Meier survival analysis. The discriminative ability of each biomarker was assessed through receiver operating characteristic (ROC) curves, time-dependent ROC analyses, and C-statistics. Additional sensitivity analyses were performed to verify the stability and reliability of the results. RESULTS: Elevated levels of all four biomarkers were significantly associated with an increased risk of adverse cardiovascular outcomes in patients with HFrEF. Each 1-SD increase in systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) was associated with a 32.5%, 46.1%, 54.0%, and 98.3% higher hazard of adverse cardiovascular outcomes, respectively. Tertile analyses showed that the increased risk of adverse cardiovascular outcomes was mainly observed in the highest biomarker tertiles. Among the four markers, SIRI showed better discriminative performance than the other indices in this cohort, with an AUC of 0.705, which was supported by time-dependent ROC and C-statistic analyses. CONCLUSION: Higher SIRI, SII, NLR, and MLR levels were associated with an increased risk of adverse cardiovascular outcomes in patients with HFrEF. SIRI showed numerically better discrimination among hospitalized patients with HFrEF in this cohort, but further external validation is required before clinical application.