Evidence map›Paper›PMID 33998162›Full record

ArticleESC heart failure2021

Neutrophil-to-lymphocyte ratio and outcomes in patients with new-onset or worsening heart failure with reduced and preserved ejection fraction.

Fraser M Curran, U Bhalraam, Mohapradeep Mohan, Jagdeep S Singh, Stefan D Anker, Kenneth Dickstein, Alexander S Doney, Gerasimos Filippatos, Jacob George, Marco Metra and 7 more

Erratum issuedOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in ESC heart failure, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 62 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
62citing papers in PubMed, 2 pooled it
9.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

62 citing papers in PubMed, 2 syntheses or guidelines pooled it, 84 citations in OpenAlex.

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  10. Prognostic Significance of the CALLY Index in Heart Failure.International journal of general medicine · 2026
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2 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 7 institutions in 7 countries.

Fraser M CurranSchool of Medicine, University of Dundee, Dundee, UK.
U BhalraamSchool of Medicine, University of Dundee, Dundee, UK.
Mohapradeep MohanDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
Jagdeep S SinghDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
Stefan D AnkerDepartment of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
Kenneth DicksteinUniversity of Bergen, Stavanger University Hospital, Stavanger, Norway.
Alexander S DoneyDivision of Population Health and Genomics, University of Dundee, Dundee, UK.
Gerasimos FilippatosHeart Failure Unit, Department of Cardiology, School of Medicine, National and Kopodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece.
Jacob GeorgeDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
Marco MetraInstitute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Leong L NgDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK.
Colin N PalmerDivision of Population Health and Genomics, University of Dundee, Dundee, UK.
Nilesh J SamaniDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK.
Dirk J van VeldhuisenDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Adriaan A VoorsDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Chim C LangDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
Ify R MordiDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.ORCID 0000-0002-2686-729X
University of Dundee · GBUniversity Medical Center Groningen · NLUniversity of Leicester · GBBerlin-Brandenburger Centrum für Regenerative Therapien · DENational and Kapodistrian University of Athens · GRStavanger University Hospital · NOSurgical Specialties (Canada) · CA

Funding

Chief Scientist Office PCL 17/07Chief Scientist Office PCL/17/07Wellcome Trust 072960/Z/03/ZWellcome Trust 084726/Z/08/ZWellcome Trust 084727/Z/08/ZWellcome Trust 085475/B/08/ZWellcome Trust 085475/Z/08/Z
6 · The paper itself

Abstract

aimsInflammation is thought to play a role in heart failure (HF) pathophysiology. Neutrophil-to-lymphocyte ratio (NLR) is a simple, routinely available measure of inflammation. Its relationship with other inflammatory biomarkers and its association with clinical outcomes in addition to other risk markers have not been comprehensively evaluated in HF patients.

methodsWe evaluated patients with worsening or new-onset HF from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study who had available NLR at baseline. The primary outcome was time to all-cause mortality or HF hospitalization. Outcomes were validated in a separate HF population.

results1622 patients were evaluated (including 523 ventricular ejection fraction [LVEF] < 40% and 662 LVEF ≥ 40%). NLR was significantly correlated with biomarkers related to inflammation as well as NT-proBNP. NLR was significantly associated with the primary outcome in patients irrespective of LVEF (hazard ratio [HR] 1.18 per standard deviation increase; 95% confidence interval [CI] 1.11-1.26, P < 0.001). Patients with NLR in the highest tertile had significantly worse outcome than those in the lowest independent of LVEF (<40%: HR 2.75; 95% CI 1.84-4.09, P < 0.001; LVEF ≥ 40%: HR 1.51; 95% CI 1.05-2.16, P = 0.026). When NLR was added to the BIOSTAT-CHF risk score, there were improvements in integrated discrimination index (IDI) and net reclassification index (NRI) for occurrence of the primary outcome (IDI + 0.009; 95% CI 0.00-0.019, P = 0.030; continuous NRI + 0.112, 95% CI 0.012-0.176, P = 0.040). Elevated NLR was similarly associated with adverse outcome in the validation cohort. Decrease in NLR at 6 months was associated with reduced incidence of the primary outcome (HR 0.75; 95% CI 0.57-0.98, P = 0.036).

conclusionsElevated NLR is significantly associated with elevated markers of inflammation in HF patients and is associated with worse outcome. Elevated NLR might potentially be useful in identifying high-risk HF patients and may represent a treatment target.

Indexed as

Heart FailureNeutrophilsHumansLymphocytesPrognosisStroke VolumeBiomarkersHeart failureInflammationNeutrophil-to-lymphocyte ratioOutcome

Identifiers

PMID33998162
PMCPMC8318449
OpenAlexW3160755803

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.