Medicine (Baltimore). 2026 Jun 26;105(26):e49313. doi: 10.1097/MD.0000000000049313.
ABSTRACT
While individual lipid and inflammatory markers have been linked to heart failure outcomes, the prognostic value of the uric acid-to-high-density lipoprotein (HDL) cholesterol ratio (UHR), neutrophil-to-HDL cholesterol ratio (NHR), and lymphocyte-to-HDL cholesterol ratio (LHR) in predicting all-cause and cardiovascular mortality remains unclear. This study assessed the association of UHR, NHR, and LHR with mortality risk in congestive heart failure (CHF) patients. A total of 1167 CHF patients were identified from the National Health and Nutrition Examination Survey 2003 to 2016, with mortality outcomes tracked via the National Death Index through 2019. UHR, NHR, and LHR were categorized into quartiles. Associations with mortality were assessed using multivariable Cox models, Kaplan-Meier analysis, and restricted cubic splines. Prognostic performance was evaluated using receiver operating characteristic (ROC) curves, time-dependent ROC, calibration curves, and decision curve analysis. SHapley Additive exPlanations values and subgroup analyses further explored model interpretability and effect modification. During a median follow-up of 67 months, 571 (48.9%) of 1167 CHF patients died, including 235 (20.1%) cardiovascular and 336 (28.8%) non-cardiovascular deaths. After multivariable adjustment, the highest quartiles of UHR and NHR were significantly associated with increased risks of all-cause and cardiovascular mortality. For UHR, the hazard ratios were 1.03 (95% confidence interval [CI] = 1.01-1.04) for all-cause and 1.03 (95% CI = 1.01-1.05) for cardiovascular mortality. In contrast, the highest quartile of LHR was associated with a reduced risk of all-cause mortality (hazard ratio = 0.67, 95% CI = 0.50-0.90). Kaplan-Meier curves indicated worse survival in higher UHR and NHR groups (log-rank P < .05), while high LHR was linked to better prognosis. Restricted cubic spline analysis revealed nonlinear associations of all 3 indices with all-cause mortality, and of NHR with cardiovascular mortality. Time-dependent ROC curves showed modest discriminative ability for UHR (areas under the curve for all-cause mortality at 1, 3, 5, and 10 years: 0.581, 0.541, 0.538, and 0.563; for cardiovascular mortality: 0.610, 0.571, 0.556, and 0.586). Subgroup analysis showed a stronger UHR-mortality association in diabetics, and age-specific differences for NHR and LHR. In this study, higher levels of UHR, NHR, and LHR were associated with increased risks of all-cause and cardiovascular mortality in CHF patients. These markers, reflecting both metabolic and inflammatory status, may help identify high-risk individuals in clinical settings.
PMID:42363516 | DOI:10.1097/MD.0000000000049313