# The impact of inflammatory burden index on the prognosis in acute decompensated heart failure: evidence from a cohort study in Jiangxi, China

## TL;DR

A new inflammatory marker called IBI is shown to predict 30-day mortality in patients with acute decompensated heart failure.

## Contribution

The study introduces and validates the inflammatory burden index (IBI) as a novel predictor of mortality in acute decompensated heart failure patients.

## Key findings

- IBI was strongly associated with 30-day mortality in ADHF patients (HR per SD increase: 1.29).
- Patients in the highest IBI tertile had a 368% higher risk of 30-day mortality compared to those in the lowest tertile.
- IBI showed higher predictive value than conventional inflammatory markers for 30-day mortality (AUC: 0.80).

## Abstract

Acute decompensated heart failure (ADHF) is the most common and severe type of HF. The aim of this study is to evaluate the impact and predictive value of a novel inflammatory marker, the inflammatory burden index (IBI), on the 30-day mortality and adverse prognosis in patients with ADHF.

This retrospective cohort study included 1,241 ADHF patients from Jiangxi Provincial People's Hospital between 2018 and 2024. The IBI was calculated as C-reactive protein × (neutrophil count/lymphocyte count). In the event analysis, the study outcome was defined as the 30-day mortality rate after hospital admission in ADHF patients. Multivariable Cox regression and receiver operating characteristic curve analysis were used to assess the impact and predictive value of the IBI on 30-day mortality. Additionally, subgroup analyses were performed to determine the risk dependency of the IBI within specific populations.

During the 30-day observation period, a total of 108 death events (8.70%) were recorded. When the study population was stratified into tertiles based on the IBI, the 30-day mortality rates were 1.93%, 4.60%, and 19.57%, respectively. Multivariable Cox regression analysis revealed a significant positive association between the IBI and 30-day mortality in ADHF patients (HR per SD increase: 1.29, 95% CI: 1.15–1.46). Compared to ADHF patients with a low IBI (T1), those with a high IBI (T3) showed a 368% higher risk of 30-day mortality (HR: 4.68, 95% CI: 1.06–13.73). Subgroup analysis revealed a significant interaction between the IBI and 30-day mortality in ADHF patients across sex subgroups (P-interaction < 0.05). In particular, compared to male patients, female ADHF patients exhibited a significantly higher risk of IBI-related in-hospital all-cause mortality (HR: 1.52 vs. 1.33). Receiver operating characteristic analysis further demonstrated that the novel inflammatory marker IBI had the highest AUC value (0.80) compared to conventional inflammatory markers, including C-reactive protein, white blood cell count, neutrophil count, lymphocyte count, and monocyte count.

The cohort study conducted in Jiangxi, China, revealed that the novel inflammatory marker IBI is significantly positively associated with 30-day mortality in ADHF patients and demonstrated strong predictive value. Incorporating IBI into the clinical management of ADHF patients may hold significant potential for preventing further disease deterioration.

Explanation: In this graphic abstract, we drew inspiration from characters in Journey to the West, a classic Chinese literary masterpiece. Here, the “White Bone Demon” (Bai Gu Jing; a shape-shifting demoness) symbolizes ADHF patients, while 'Sun Wukong' (the Monkey King) represents physicians. As depicted, the physician, akin to Sun Wukong, employs his fiery golden eyes (a metaphor for clinical acumen) to identify the IBI (represented by a skull icon) as the key risk factor in the ADHF patient.Illustration of a traditional Eastern art style showing a scene with three characters and a pie chart labeled with ADHF prognostic factors. A monk, a young person with a heart and wheelchair symbol, and a monkey-like figure with a staff are depicted. The background includes mountains, clouds, and a rock with a jug and peach. Text at the top reads, \"Identifying Important Prognostic Factors in ADHF Patients with Keen Insight (IBI).\"

Explanation: In this graphic abstract, we drew inspiration from characters in Journey to the West, a classic Chinese literary masterpiece. Here, the “White Bone Demon” (Bai Gu Jing; a shape-shifting demoness) symbolizes ADHF patients, while 'Sun Wukong' (the Monkey King) represents physicians. As depicted, the physician, akin to Sun Wukong, employs his fiery golden eyes (a metaphor for clinical acumen) to identify the IBI (represented by a skull icon) as the key risk factor in the ADHF patient.