Association of Pan-Immune-Inflammation Value with In-Hospital Mortality in Acute Decompensated Heart Failure with Reduced Ejection Fraction

Aim: Systemic inflammation contributes to the pathogenesis and prognosis of heart failure. The pan-immune-inflammation value (PIV) is a novel biomarker reflecting the balance between pro- and anti-inflammatory immune components. This study investigated the relationship between PIV and in-hospital mortality in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF). Materials and Methods: This retrospective study included 346 patients hospitalized with ADHF and HFrEF at a tertiary center between January 2022 and May 2025. Clinical, laboratory, and echocardiographic data were retrieved. PIV was calculated as (neutrophils × platelets × monocytes) / lymphocytes. The primary endpoint was in-hospital mortality. Prognostic performance was evaluated using ROC curve analysis and multivariable logistic regression. Results: In-hospital mortality occurred in 65 patients (18.8%). The mortality group had lower systolic blood pressure, glomerular filtration rate, sodium, albumin, and LVEF, while CRP, monocyte count, and PIV were higher (all p < 0.05). PIV predicted mortality with an AUC of 0.735 (95% CI: 0.667–0.796, p < 0.001). A cut-off of 883.07 provided 76.8% sensitivity and 70.4% specificity. In multivariable analysis, PIV independently predicted mortality both as a continuous variable (OR: 1.002, 95% CI: 1.001–1.003, p < 0.001) and as a categorical variable above the cut-off (OR: 3.893, 95% CI: 2.057–7.369, p < 0.001). Conclusion: PIV is an independent predictor of in-hospital mortality in patients with ADHF and reduced EF. As a simple, inexpensive, and widely available marker, PIV may facilitate early risk stratification in clinical practice.