Advanced lung cancer inflammation index is associated with mortality in critically ill patients with heart failure

Abstract

Aims: Nutrition and inflammation status play a vital role in the prognosis of patients with heart failure (HF). This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a novel composite indicator of inflammation and nutrition, and short-term mortality among critically ill patients with HF.

Methods: This retrospective study included 548 critically ill patients with HF from the MIMIC-IV database. ALI was computed using body mass index, serum albumin and neutrophil-lymphocyte ratio. The primary endpoint was all-cause in-hospital mortality, and the secondary endpoint was 90 day mortality. Kaplan-Meier survival curve analysis with long-rank test and Cox proportional hazards regression models were employed to assess the relationship between baseline ALI and short-term mortality risk. The incremental predictive ability of ALI was evaluated by C-statistic, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: The average age of 548 patients was 72.2 (61.9, 82.1) years, with 60% being male. Sixty-three patients (11.5%) died in the hospital, and 114 patients (20.8%) died within 90 days of intensive care unit admission. The Kaplan-Meier analysis revealed that the cumulative incidences of both in-hospital and 90 day mortality were significantly higher in patients with lower ALI (log-rank test, in-hospital mortality: P < 0.001; 90 day mortality: P < 0.001). The adjusted Cox proportional hazard model revealed that ALI was inversely associated with both in-hospital and 90 day mortality after adjusting for confounders [hazard ratio (HR) (95% confidence interval) (CI): 0.97 (0.94, 0.99), P = 0.035; HR (95% CI): 0.62 (0.39, 0.99), P = 0.046]. A linear relationship was observed between ALI and in-hospital mortality (P for non-linearity = 0.211). The addition of ALI significantly improved the prognostic ability of GWTG-HF score in the in-hospital mortality [C-statistic improved from 0.62 to 0.68, P = 0.001; continuous NRI (95% CI): 0.44 (0.20, 0.67), P < 0.001; IDI (95% CI): 0.03 (0.01, 0.04), P < 0.001] and 90 day mortality [C-statistic improved from 0.63 to 0.70, P < 0.001; continuous NRI (95% CI): 0.31 (0.11, 0.50), P = 0.002; IDI (95% CI): 0.01 (0.00, 0.02), P = 0.034]. Subgroup analysis revealed stronger correlations between ALI and in-hospital mortality in males and patients aged over 65 years (interaction P = 0.031 and 0.010, respectively). The C-statistic of in-hospital mortality in patients over 65 years was 0.66 (95% CI: 0.58, 0.74).

Conclusions: ALI at baseline can independently predict the risk of short-term mortality in critically ill patients with HF, with lower ALI significantly associated with higher mortality. Further large prospective research with extended follow-up periods is necessary to validate the findings of this study.

Keywords: advanced lung cancer inflammation index; critically ill patients with heart failure; inflammation; nutrition; prognosis.

Figure 1

Kaplan–Meier survival curves for in‐hospital mortality across the ALI tertiles. ALI, advanced lung cancer inflammation index.

Figure 2

Non‐linear dose–response relationship between ALI and in‐hospital mortality. Adjusted for age, gender, SOFA score, systolic blood pressure, smoking status, alcohol intake and glucose. The solid line and light purple area represent the estimated values and their corresponding 95% confidence intervals. ALI, advanced lung cancer inflammation index; CI, confidence interval; HR, hazard ratio; SOFA, Sequential Organ Failure Assessment.

Figure 3

Association between ALI and in‐hospital mortality according to baseline characteristics. Each stratification adjusted for all covariates in Model 4. CI, confidence interval; eGFR, estimated glomerular filtration rate; HR, hazard ratio.