Backgrounds: Recently, it has been reported that hypochloremia is associated with poor outcome in patients (pts) with chronic heart failure (CHF), and we previously reported that persistent hypochloremia (per-hypoCl) had more prognostic significance than persistent hyponatremia in CHF pts. On the other hand, neutrophil to lymphocyte ratio (NLR) provides prognostic information in pts with CHF. However, there is no information available on the long-term prognostic value of combining NLR and cardiac MIBG imaging in CHF pts.
Methods and Results: We studied 120 CHF outpatients with LVEF <40% in our prospective cohort study. We measured serum chloride and sodium concentration at entry and every 6month for the initial 3 years. Per-hypoCl was defined that hypochloremia (≤99mEq/L) was observed for more than 6 months. We also measured other laboratory data including complete blood count at entry. During a follow up period of 8.4±4.3 years, 51 patients had cardiac events, defined as readmission for worsening heart failure or cardiac death (WHF/CD). At multivariate Cox analysis, NLR (p=0.0004) and per-hypoCl (p=0.0008), but not persistent hyponatremia, were significantly associated with WHF/CD independently of LVEF and serum uric acid level. The receiver operator characteristic curve (ROC) analysis revealed that NLR of 1.867 was a fair discriminator for WHF/CD (area under the curve 0.742 (95% CI 0.65-0.82)). Kaplan-Meier analysis in the subgroup with low NLR revealed that WHF/CD was significantly more frequently observed in pts with than those without per-hypoCl (39% vs 14% p=0.019, adjusted HR 4.0 [1.3-12.6]). Furthermore, in the subgroup with high NLR, the incidence of WHF/CD was also significantly higher in pts with than in those without per-hypoCl (84% vs 46% p=0.0004, adjusted HR 3.4 [1.7-6.7]).
Conclusion: The combination of persistent hypochloremia and NLR could provide the improved prediction of poor outcome in CHF pts.