Association of routine inflammatory biomarkers and derived indices with heart failure progression in preserved ejection fraction

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is driven by systemic inflammation, yet the prognostic utility of routine inflammatory biomarkers and derived indices remains underexplored. This study evaluates the association of high-sensitivity C-reactive protein (hsCRP), albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and pan-immune-inflammatory value (PIV) with HFpEF outcomes. METHODS: In a retrospective cohort of 312 HFpEF patients (mean age 72.6 ± 10.1 years, 54% female) from Tokat Gaziosmanpasa University Hospital (2018-2022), we analyzed baseline and longitudinal trends in biomarkers using electronic health records. Multivariable Cox models assessed associations with heart failure hospitalization and all-cause mortality, with subgroup analyses in obese, diabetic, and high-inflammatory (hsCRP > 3 mg/L) patients. A composite inflammatory score (hsCRP, SII, PIV) was evaluated for predictive accuracy. RESULTS: Over a median 22-month follow-up, 82 patients (26.3%) experienced hospitalization, and 48 (15.4%) died. Baseline hsCRP (HR 1.09 per mg/L, p = 0.011), NLR (HR 1.14 per unit, p = 0.002), and lower albumin (HR 0.68 per g/dL, p = 0.020) predicted hospitalization, as did longitudinal increases in hsCRP and NLR (p < 0.001). SII and PIV were significant in diabetic and high-inflammatory subgroups, respectively. The composite score improved hospitalization prediction (AUC 0.78 vs. 0.71 for hsCRP, p = 0.042). CONCLUSION: Routine inflammatory biomarkers, particularly their longitudinal trends, predict HFpEF progression. The composite score offers a practical tool for risk stratification, guiding personalized management in community settings.