Prognostic value of the NAPLES score in patients undergoing LVAD implantation: comparison with established nutritional indices

BACKGROUND: Nutritional status plays a critical role in patients with advanced heart failure (HF) undergoing left ventricular assist device (LVAD) implantation. However, the comparative prognostic value of different nutritional and inflammatory indices in this population remains unclear. The present study aimed to evaluate the prognostic value of the NAPLES score and compare its performance with other established nutritional and inflammatory indices in patients undergoing LVAD implantation. METHODS: We retrospectively analyzed consecutive patients who underwent LVAD implantation at a tertiary center. Nutritional indices, including the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score and NAPLES score, were calculated using preoperative laboratory data. The primary outcome was all-cause mortality. Competing risk analyses were performed using Fine-Gray models, accounting for heart transplantation as a competing event. Multivariable models were adjusted for clinically relevant covariates. RESULTS: A total of 190 patients were included. During follow-up, all-cause mortality occurred more frequently in patients with higher NAPLES scores. In univariate analysis, several nutritional indices were associated with mortality; however, in multivariable analysis, the NAPLES score remained the most robust predictor. Patients in the high NAPLES group had a significantly increased risk of mortality compared to those in the low-risk group. When analyzed as a continuous variable, higher NAPLES scores were independently associated with increased mortality risk. In contrast, the predictive value of CONUT and HALP scores was attenuated after adjustment. CONCLUSIONS: Among commonly used nutritional and inflammatory indices, the NAPLES score demonstrated the strongest and most consistent association with all-cause mortality in patients undergoing LVAD implantation. Incorporating the NAPLES score into routine preoperative assessment may improve risk stratification in this high-risk population.