Neutrophil to Lymphocyte Ratio, NTproBNP and Six-minute Walk Test as Predictors of Readmission and Mortality in Patients with Heart Failure: A Prospective Observational Study

1. Third Year Postgraduate, Department of General Medicine, SRM Medical College Hospital and Research Center, Chengalpattu, Tamil Nadu, India. 2. Professor, Department of General Medicine, SRM Medical College Hospital and Research Center, Chengalpattu, Tamil Nadu, India. 3. Assistant Professor, Department of General Medicine, SRM Medical College Hospital and Research Center, Chengalpattu, Tamil Nadu, India. 4. Senior Resident, Department of General Medicine, SRM Medical College Hospital and Research Center, Chengalpattu, Tamil Nadu, India.

Abstract

Introduction: Heart Failure (HF) is a leading cause of morbidity and mortality worldwide, with a high-risk of hospital readmission. Identifying reliable prognostic markers is crucial for optimising clinical management. N-terminal pro-B-type natriuretic peptide (NTproBNP), Neutrophil-To-Lymphocyte Ratio (NLR), and the Six-Minute Walk Test (6MWT) have emerged as key predictors of HF outcomes.

Aim: The present study evaluates the predictive value of NTproBNP, NLR, and the 6MWT in assessing mortality and readmission risks in HF patients.

Materials and Methods: In the present prospective observational study, 170 HF patients were enrolled over 18 months. NTproBNP and NLR were measured at admission; 6MWT was conducted at discharge. Patients were followed for 90 days to assess mortality and readmission. Receiver Operating Characteristic (ROC) analysis determined cut-off values and predictive accuracy.

Results: Mortality occurred in 14 patients (8.2%) and readmission in 19 patients (11.2%). NTproBNP levels were significantly higher in mortality (28,114.29±6799.08 pg/mL) and readmission groups (21,242.63±9553.81 pg/mL) with AUCs of 0.98 and 0.92, respectively (p<0.0001). NLR was elevated in mortality (6.70±2.53; AUC=0.64) and readmission groups (7.88±4.93; AUC=0.67). 6MWT distances were reduced in mortality (170.00±49.92 m; AUC=0.978) and readmission (214.74±73.66 m; AUC=0.915).

Conclusion: NTproBNP and 6MWT are effective prognostic markers in HF, enhancing risk stratification. NTproBNP was the most predictive, 6MWT assessed functional status, and NLR reflected inflammation’s role.

Cardiac biomarkers, Cardiac failure, Prognosis, Ventricular function