Neutrophil-Albumin Ratio as a Predictor of in-Hospital Mortality in Patients with Cardiogenic Shock

Abstract

Intoduction: Cardiogenic shock (SK) is the most severe phase of the acute heart failure syndrome. One of the most widely studied inflammatory mediators in cardiogenic shock is neutrophils. Albumin has several functions, including in pressure regulation, plays a role as an antioxidant and anti-inflammatory agent. Several studies have shown the association of albumin levels with mortality in patients with cardiogenic shock. Purpose: This study aimed to evaluate the utilization of neutrophil-albumin ratio (NAR) in predicting in-hospital mortality in patients with cardiogenic shock (CS) Patients and methods: This study was an observational study with cross sectional design conducted at the Department of Cardiovascular, Harapan Kita Cardiovascular Hospital. The data were collected from the patient registry (January 2018 to April 2020). The study participants were all patients with cardiogenic shock admitted to our hospital. The endpoint was in-hospital mortality in CS patients. Predictors of hospital mortality were identified using multivariable logistic regression, followed by receiver operator characteristic (ROC) curve analysis and cut-off value for optimal NAR level. Results: A total of 130 patients hospitalized with CS were enrolled in this study, In-hospital mortality was found in 75 (57,7%) patients, among which 102 (78,5%) were male and 101 (77,7%) patients had acute coronary syndrome. There was a significant positive correlation between NAR levels and in-hospital mortality. The multivariate logistic regression showed that NAR was independently associated with increased risk of in-hospital mortality with odd ratio (OR) of 5,81, 95% confidence interval (CI) 2,303 - 14,692, P <0,001. NAR had a prognostic value in predicting in-hospital mortality of CS based on ROC curve analysis (AUC 0,802), with an optimal NAR cut-off value of 25. Conclusion: NAR is independently associated with in-hospital mortality in patients with CS Keywords: Neutropil-albumin ratio, cardiogenic Shock, mortality predictor