Association of Left Ventricular Ejection Fraction with Inflammation Parameters and Indexes

Objective: Left ventricular ejection fraction (LVEF) measurement through transthoracic echocardiography is the recommended parameter for evaluating LV systolic functions. This retrospective study aimed to evaluate the association of LVEF with inflammatory biomarkers and indexes including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI).
Methods: After the application of exclusion criteria, 854 patients remained for statistical analyses. NLR, PLR, SII and SIRI were calculated from admission complete blood count test. Patients with LVEF ≥50% were defined as preserved LVEF (pLVEF), LVEF 41-49% mildly reduced LVEF (mrLVEF) and LVEF ≤40% reduced LVEF (rLVEF). LVEF <50% was defined as impaired LVEF.
Results: Patients were classified into three groups with respect to their LVEF namely pLVEF (n=784), mrLVEF (n=24) and rLVEF (n=46). PLR and SII levels were comparable between groups. Patients with mrLVEF and rLVEF had higher NLR and SIRI levels compared to pLVEF patients. The area under the curve (AUC) values for NLR, PLR, SII and SIRI to predict impaired LVEF were 0.59, 0.54, 0.55, and 0.63, respectively. The AUC values for NLR, PLR, SII and SIRI for predicting mrLVEF were 0.61, 0.55, 0.55, and 0.65, respectively. The AUC values for NLR, PLR, SII and SIRI to predicting rLVEF were 0.58, 0.53, 0.54, and 0.61, respectively. Multivariate regression analysis revealed age, coronary artery disease (CAD) and SIRI (odds ratio: 1.39, 95% confidence interval (CI): 1.09-1.76, p=0.007) as independent predictors of impaired LVEF. Multinomial logistic regression analysis performed for evaluating predictors of mrLVEF and rLVEF in contrast to pLVEF demonstrated that CAD independently predicts mrLVEF, whereas CAD and SIRI (odds ratio: 1.42, 95% CI: 1.09-1.84, p=0.009) are independent predictors of rLVEF.
Conclusion: SIRI is a novel biomarker that is associated with impaired LVEF and rLVEF but not mrLVEF.