Association of Systemic Inflammation Level on Admission with Total and Cardiovascular­Specific Death in Heart Failure with Preserved Ejection Fraction: A Large Multi­Center Retrospective Longitudinal Study.

ABSTRACT

Purpose: Heart failure with preserved ejection fraction (HFpEF) is inherently a complex inflammatory syndrome, and heightened inflammation is strongly associated with an increased risk of death. However, the association of systemic inflammation levels with total and cardiovascular death among patients with HFpEF remains unknown. We aimed to investigate the prognostic impact of systemic inflammation on all-cause and cardiovascular death among patients with HFpEF. Patients and Methods: Patients with HFpEF were included in this study. Systemic inflammation response index (SIRI) is defined as the multiplication of neutrophil and monocyte divided by lymphocyte count, and patients were divided into four groups based on SIRI quartiles. Cox regression models and competing risk models were used to examine the relationships between SIRI and total and cardiovascular­specific mortality, respectively. Results: 9,986 patients with HFpEF were included in five tertiary hospitals. During a median follow-up period of 4.4 years, a total of 2004 patients died, of which 965 were cardiovascular deaths. After fully adjusting for confounders, elevated SIRI level was significantly related to the increased risk of all-cause death (Q2, Q3, Q4 adjusted hazard ratio (aHR) [95 confidence interval (CI)%] =1.17[1.01-1.35], 1.31[1.13-1.52], 1.51[1.30-1.76], respectively; P for trend <0.001). The elevated quartile of SIRI showed higher risks of cardiovascular death, but there was no statistically significant increased risk of cardiovascular death across the lower SIRI quartile (model 3 Q2, Q3, Q4 aHR [95CI%] =1.22[0.99-1.51], 1.50[1.20-1.86], 1.73[1.37-2.18], respectively; P for trend <0.001). Conclusion: Elevated systemic inflammation level on admission was correlated with an increased risk of all-cause and cardiovascular death among patients with HFpEF. The SIRI may serve as a promising marker of risk stratification for patients with HFpEF.