# Evaluation of the prognosis of elderly patients with heart failure by Monocyte-to-High-Density Lipoprotein Ratio, Neutrophil Gelatinase-Associated Lipocalin, and Angiotensin II

## TL;DR

This study examines how three biomarkers—MHR, NGAL, and Ang II—can predict short- and long-term mortality in elderly patients with heart failure.

## Contribution

The study identifies MHR as a potentially reliable predictor of mortality in elderly heart failure patients compared to NGAL and Ang II.

## Key findings

- MHR, NGAL, and Ang II are all linked to increased mortality risk in elderly heart failure patients.
- MHR showed the highest predictive power with AUC values of 0.740 for one-month and 0.728 for one-year mortality.
- Optimal thresholds for MHR, NGAL, and Ang II were identified for predicting mortality at one month and one year.

## Abstract

The objective of this research was to investigate the correlation between the Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR), Neutrophil gelatinase-associated lipocalin (NGAL), and Angiotensin II (Ang II) with both short-term and long-term mortality rates in elderly patients with heart failure (HF).

A retrospective cohort study was conducted, encompassing elderly HF patients hospitalized from 2020 to 2023. Multivariable logistic regression analysis was employed to assess the relationship between MHR, NGAL, Ang II, and mortality risk.

The predictive power of these biomarkers for mortality in patients with HF was determined using the area under the receiver operating characteristic curve (AUC). Each of the biomarkers—MHR, NGAL, and Ang II—was linked to an increased risk of mortality at one month (OR = 1.007, 95% CI: 1.003–1.012), (OR = 1.004, 95% CI: 1.001–1.007), (OR = 1.002, 95% CI: 1.001–1.004) and at one year (OR = 1.007, 95% CI: 1.002–1.011), (OR = 1.004, 95% CI: 1.001–1.008), (OR = 1.003, 95% CI: 1.001–1.006) in the elderly patients with HF. The AUC for MHR, NGAL, and Ang II in forecasting one-month mortality were 0.740 (95% CI: 0.668–0.811), 0.659 (95% CI: 0.581–0.738), and 0.628 (95% CI: 0.547–0.710), respectively. For one-year mortality, the AUC values were 0.728 (95% CI: 0.655–0.800), 0.641 (95% CI: 0.560–0.721), and 0.627 (95% CI: 0.546–0.708), respectively. The optimal thresholds for MHR, NGAL, and Ang II in predicting one-month mortality were identified as 0.52, 85 ng/ml, and 25 pg/ml, respectively, while for one-year mortality, the thresholds were 0.50, 70 ng/ml, and 24 pg/ml, respectively.

MHR, NGAL, and Ang II emerge as promising indicators for mortality prediction in HF patients. Among these, MHR stands out as potentially the most reliable predictor of mortality in the elderly with HF.