Neutrophil-Lymphocyte Ratio as Predictor of Prognosis In Patient with Heart Failure with Reduced Ejection Fraction that Treated With Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Neprilysin Inhibitor: A Prospective Cohort Study in A

Introduction: Heart failure (HF) and inflammation are related. Angiotensin Converting Enzyme Inhibitors (ACE-I) and Angiotensin Receptor Neprilysin Inhibitors (ARNI) can reduce inflammation by lowering neutrophil counts. The neutrophil-lymphocyte ratio (NLR) is a simple marker of inflammation. There is a lack of studies showing that NLR can predict prognosis in patients with HFrEF, and further investigation is needed.Objectives: Investigating whether NLR could be a prognostic indicator for mortality and rehospitalization in patients with heart failure and reduced ejection fraction receiving treatment with ACE-I or ARNI.Methods: A prospective observational cohort study with double-blind methods was conducted at Zainal Abidin General Hospital, Banda Aceh, Indonesia. Two groups, ACE-I and ARNI, each comprised 40 participants. Initially, blood sampling was performed to determine NLR. Participants were observed weekly for three months for prognosis outcomes (death and rehospitalization). After three months, the remaining participants were invited for re-evaluation of the NLR.Results: This study found that pre-treatment NLR had a hazard ratio (HR) of 1.454 (95% CI: 1.266-1.670, p < 0.001). The risk ratio of abnormal pre-treatment NLR for rehospitalization was 6.56 in the ACE-I group and 8.33 in the ARNI group. Nevertheless, both ACE-I (p = 0.014) and ARNI (p = 0.032) decreased NLR levels.Conclusions: High NLR could be as a predictor of prognosis in patients with heart failure with a decrease in left ventricular ejection fraction that treated with ACE-I or ARNI, also ACE-I and ARNI could reduce NLR levels.