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Background <p>Inflammatory and hepatic biomarkers have been increasingly studied in heart failure (HF) for their potential prognostic value. This study aimed to evaluate the association of the neutrophil-to-lymphocyte ratio (NLR) and the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) with reduced left ventricular ejection fraction (LVEF ≤ 40%) in HF patients.</p> Methods <p>A cross-sectional study was conducted involving 439 patients diagnosed with HF according to European Society of Cardiology (ESC) 2021 definition. Patients were stratified by NLR (&lt; 3 vs. ≥ 3) and AST/ALT ratio (&lt; 1 vs. ≥ 1). Clinical and laboratory parameters were compared. Multivariate logistic regression was used to identify independent predictors of reduced LVEF, and receiver operating characteristic (ROC) analysis assessed the discriminative ability of NLR, AST/ALT ratio, and brain natriuretic peptide (BNP).</p> Results <p>Patients with high NLR (≥ 3) had significantly higher age, NYHA class, BNP, C-reactive protein (CRP), AST/ALT ratio, and serum creatinine, along with lower estimated glomerular filtration rate (eGFR) and LVEF (<i>p</i> &lt; 0.05). The AST/ALT ≥ 1 group also exhibited higher inflammatory and renal markers, but there was no significant difference in LVEF. Multivariate analysis showed NLR was independently associated with reduced LVEF (OR = 1.132, 95% CI: 1.054–1.215, <i>p</i> &lt; 0.001), while AST/ALT ratio was not. ROC analysis demonstrated limited predictive value of NLR (AUC = 0.577) and no predictive value for AST/ALT ratio (AUC = 0.494).</p> Conclusion <p>NLR was independently associated with reduced LVEF, although its predictive accuracy was limited; in contrast, the AST/ALT ratio did not demonstrate significant predictive value.</p>

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Relationship between AST/ALT ratio and Neutrophil-to-Lymphocyte ratio (NLR) with reduced left ventricular ejection fraction in heart failure: a cross-sectional analysis

  • 期刊论文

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  • 发表日期：

    2025年9月13日

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  • Dodji Kossi Djakpo,
  • Xingxiang Wang

摘要

Background

Inflammatory and hepatic biomarkers have been increasingly studied in heart failure (HF) for their potential prognostic value. This study aimed to evaluate the association of the neutrophil-to-lymphocyte ratio (NLR) and the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) with reduced left ventricular ejection fraction (LVEF ≤ 40%) in HF patients.

Methods

A cross-sectional study was conducted involving 439 patients diagnosed with HF according to European Society of Cardiology (ESC) 2021 definition. Patients were stratified by NLR (< 3 vs. ≥ 3) and AST/ALT ratio (< 1 vs. ≥ 1). Clinical and laboratory parameters were compared. Multivariate logistic regression was used to identify independent predictors of reduced LVEF, and receiver operating characteristic (ROC) analysis assessed the discriminative ability of NLR, AST/ALT ratio, and brain natriuretic peptide (BNP).

Results

Patients with high NLR (≥ 3) had significantly higher age, NYHA class, BNP, C-reactive protein (CRP), AST/ALT ratio, and serum creatinine, along with lower estimated glomerular filtration rate (eGFR) and LVEF (p < 0.05). The AST/ALT ≥ 1 group also exhibited higher inflammatory and renal markers, but there was no significant difference in LVEF. Multivariate analysis showed NLR was independently associated with reduced LVEF (OR = 1.132, 95% CI: 1.054–1.215, p < 0.001), while AST/ALT ratio was not. ROC analysis demonstrated limited predictive value of NLR (AUC = 0.577) and no predictive value for AST/ALT ratio (AUC = 0.494).

Conclusion

NLR was independently associated with reduced LVEF, although its predictive accuracy was limited; in contrast, the AST/ALT ratio did not demonstrate significant predictive value.