The Appraised Value Of Neutrophil To Lymphocyte Ratio Combined With NT-proBNP In Hospital Death In Patients With Acute Exacerbation Of Chronic Heart Failure

Objective:To compare the predictive value of neutrophil to lymphocyte ratio(NLR),N-terminal brain natriuretic peptide precursor NT-proBNP and NLR combined with NT-proBNP for in-hospital mortality in patients with acute exacerbation of chronic heart failure.Methods:From September 2020 to September 2022,118 patients with acute exacerbation of chronic heart failure were selected from the Department of Emergency Medicine or Department of Cardiovascular Medicine,Affiliated Hospital of Guizhou Medical University,the patients were divided into death group(N=35)and survival group(N=83).Neutrophil(NEU),Lymphocyte(LYM),Alanine aminotransferase(ALT),Aspartic transaminase(AST),Total Bilirubin(TBIL)and NT-proBNP were detected within 24 hours after admission,echocardiography was performed within 72 hours of admission,and all patients were treated according to the 2018 Chinese guidelines for the treatment of heart failure.SPSS 27.0 software was used for statistical analysis of the data.Results:(1)Compared with the survival group,NEU,LYM,NLR,NT-proBNP,age were significantly increased and LVEF was significantly decreased in the death group;The differences of NEU,LYM,NLR,NT-proBNP,age and LVEF between the survival group and the death group were statistically significant(p<0.05);Sex,BMI,heart rate,systolic blood pressure,diastolic blood pressure,history of drug use,history of lipid-lowering drug use,history of Antiplatelet drug use,history of hypertension,history of diabetes mellitus,history of smoking,history of alcohol consumption,ALT、AST、TBIL etc.There was no significant difference(p>0.05).(2)NLR(OR=3.487,95%CI:1.502～8.092,p=0.004),NT-proBNP(OR=1.001,95%CI:1.000～1.001,p=0.001),age(OR=1.067,95%CI:1.017～1.120,p=0.008)were independent risk factors of in-hospital death in patients with acute exacerbation of chronic heart failure(OR=9.427,95%CI:1.887～47.09,p=0.006).(3)According to the ROC(Receiver Operating Characteristic)Curve,the Area Under the Curve(AUC)of NLR combined with NT-proBNP was higher than that of NLR and NT-proBNP alone.The AUC of NLR combined with NT-proBNP was 0.979.The AUC of NLR was 0.875.The AUC of NT-proBNP was 0.958 respectively.NLR≤4.320 and NT-proBNP ≤7.319 pg/ml were the best predictive cut-off points for in-hospital mortality(AUC were respectively 0.875 and 0.958.).Conclusion:(1)NLR,NT-proBNP and age are independent predictors of in-hospital mortality in patients with acute exacerbation of chronic heart failure.(2)Combined detection of NLR and NT-proBNP is better than that of single index in predicting in-hospital mortality in patients with acute exacerbation of chronic heart failure,and it has guiding significance in identifying patients with acute exacerbation of chronic heart failure who may die in hospital.