Inflammation Markers in Heart Failure Prognosis
Summary
Chronic inflammation is now recognised as a key driver of myocardial remodelling, functional decline and adverse outcomes in heart failure. Circulating biomarkers that capture the balance between innate and adaptive immune responses have emerged as inexpensive, widely available tools to refine risk stratification, guide therapeutic decisions and monitor response to treatment. Ratios derived from routine blood counts—such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR)—reflect shifts in myeloid and lymphoid compartments that parallel activation of pro-inflammatory cytokines and endothelial dysfunction. Composite indices incorporating serum proteins (albumin, apolipoprotein A1), red cell distribution width and platelet counts extend prognostic insight by integrating nutritional, haemodynamic and inflammatory signals. Novel indices of systemic immune-inflammation and inflammation-nutritional interplay have demonstrated independent associations with rehospitalisation, medium-term mortality and major adverse cardiovascular events across the spectrum of acute decompensated and chronic heart failure. By capturing dynamic changes in cellular immunity, these markers offer a real-time window into evolving disease activity, supporting early identification of high-risk patients and informing personalised management strategies in diverse clinical settings.
Research from Nature Portfolio
Recent clinical research has illustrated the prognostic value of the platelet-to-lymphocyte ratio in acute heart failure. In a multicentre cohort of hospitalised patients with decompensated heart failure, higher PLR quartiles were independently associated with significantly lower six-month survival rates in a graded fashion. Patients in the highest PLR group exhibited a two- to threefold increase in mortality risk after adjustment for traditional risk factors. These findings underscore PLR as a rapid, inexpensive marker that may complement natriuretic peptides and imaging parameters to refine early risk stratification and optimise discharge planning.
Inflammation Markers in Heart Failure Prognosis publication trend
The graph below shows the total number of articles in inflammation markers in heart failure prognosis across all publications each year (not limited to Nature Index journals).
Technical terms
Neutrophil-to-lymphocyte ratio (NLR): Ratio of absolute neutrophil count to lymphocyte count, indicating balance between innate and adaptive immunity.
Platelet-to-lymphocyte ratio (PLR): Ratio of platelet count to lymphocyte count, reflecting thrombo-inflammatory activity.
Neutrophil percentage-to-albumin ratio (NPAR): Proportion of neutrophils relative to serum albumin concentration, integrating inflammation and nutritional status.
Systemic inflammation response index (SIRI): Composite index of neutrophils, monocytes and lymphocytes, quantifying overall immune-inflammatory burden.
Naples prognostic score (NPS): Multicomponent score including albumin, cholesterol, neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio to predict long-term mortality.
Red blood cell distribution width-to-platelet ratio (RPR): Ratio evaluating size variability of erythrocytes against platelet count, associated with readmission risk.
References
- The importance of Naples prognostic score in predicting long-term mortality in heart failure patients. Annals of Medicine (2024).
- Association between red blood cell distribution width-to-platelet ratio and post-discharge readmission rate in patients with heart failure: A retrospective cohort study. Heliyon (2024).
- The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Scientific Reports (2019).
- Systemic Inflammation Response Index Is a Promising Prognostic Marker in Elderly Patients With Heart Failure: A Retrospective Cohort Study. Frontiers in Cardiovascular Medicine (2022).
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