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Peer-reviewedCC BY-NC-NDJournal of cardiothoracic surgery

Inflammatory and immune-nutritional indices as prognostic markers of mortality after cardiac procedures: evidence from MIMIC-IV.

  • Danyal Yarahmadi1,2
  • Fatemeh Naseri Rad3
  • Mohammad Baadkoube Hazaveh3
  • Yasaman Vaseghi4
  • Ali Rafatnia5
  • Abbas Mohammadi4
  • Carmel Moazez6
  • Babak Goodarzy3
  • Mohammad Mahdi Kakoienejad3
  • Samira Eslami7
7 affiliations
  1. 1Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Hemat Highway, next to Milad Tower, Tehran, Iran. [email protected].
  2. 2Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. [email protected].
  3. 3Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Hemat Highway, next to Milad Tower, Tehran, Iran.
  4. 4Internal Medicine Residency, Valley Health System, Las Vegas, NV, USA.
  5. 5Internal Medicine Department, Valley Health System, Las Vegas, NV, USA.
  6. 6Nevada Cardiology Associate, Las Vegas, NV, USA.
  7. 7Cardiology Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Abstract

Background

Inflammation-based hematologic indices derived from routine preoperative labs, Hemoglobin-Albumin-Lymphocyte-Platelet (HALP), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), red blood cell distribution width-to-albumin ratio (RAR), and Systemic Inflammation Response Index (SIRI), capture physiologic reserve and immune activation. Their peri-procedural prognostic role across contemporary cardiac interventions, however, remains incompletely defined.Methods

We performed a retrospective MIMIC-IV cohort study of open or percutaneous cardiac procedures. HALP, PLR, NLR, SII, SIRI, and RAR were quality-controlled, recalculated, and modeled on the log2 scale. Cox models estimated associations with 90-day and 1-year mortality; spline, strict-preoperative, threshold, and incremental-performance analyses were performed.Results

The cohort included 14,566 cardiac-procedure records. After adjustment, RAR, NLR, SIRI, and SII were associated with higher 90-day and 1-year mortality, whereas HALP showed inverse associations and PLR was less consistent. Strict-preoperative analyses supported RAR, NLR, and SIRI. Spline analyses suggested graded nonlinear risk, and RAR provided the largest modest incremental performance gain.Conclusion

In patients undergoing cardiac procedures, inflammatory and immune-nutritional indices showed clinically coherent associations with mortality. RAR, NLR, and SIRI were the most consistent adverse markers, while HALP was protective. These indices provide modest adjunctive prognostic information and warrant prospective validation.

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Cite

BibTeXRIS
BibTeX
@article{yarahmadi2026inflammatory,
  title = {{Inflammatory and immune-nutritional indices as prognostic markers of mortality after cardiac procedures: evidence from MIMIC-IV.}},
  author = {Danyal Yarahmadi and Fatemeh Naseri Rad and Mohammad Baadkoube Hazaveh and Yasaman Vaseghi and Ali Rafatnia and Abbas Mohammadi and Carmel Moazez and Babak Goodarzy and Mohammad Mahdi Kakoienejad and Samira Eslami},
  journal = {Journal of cardiothoracic surgery},
  year = {2026},
  month = aug,
  doi = {10.1186/s13019-026-04651-3},
  url = {https://europepmc.org/article/MED/42958282},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Inflammatory and immune-nutritional indices as prognostic markers of mortality after cardiac procedures: evidence from MIMIC-IV.
AU  - Danyal Yarahmadi
AU  - Fatemeh Naseri Rad
AU  - Mohammad Baadkoube Hazaveh
AU  - Yasaman Vaseghi
AU  - Ali Rafatnia
AU  - Abbas Mohammadi
AU  - Carmel Moazez
AU  - Babak Goodarzy
AU  - Mohammad Mahdi Kakoienejad
AU  - Samira Eslami
PY  - 2026
DA  - 2026/08/01
JO  - Journal of cardiothoracic surgery
DO  - 10.1186/s13019-026-04651-3
UR  - https://europepmc.org/article/MED/42958282
AB  - Background  Inflammation-based hematologic indices derived from routine preoperative labs, Hemoglobin-Albumin-Lymphocyte-Platelet (HALP), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), red blood cell distribution width-to-albumin ratio (RAR), and Systemic Inflammation Response Index (SIRI), capture physiologic reserve and immune activation. Their peri-procedural prognostic role across contemporary cardiac interventions, however, remains incompletely defined.Methods  We performed a retrospective MIMIC-IV cohort study of open or percutaneous cardiac procedures. HALP, PLR, NLR, SII, SIRI, and RAR were quality-controlled, recalculated, and modeled on the log2 scale. Cox models estimated associations with 90-day and 1-year mortality; spline, strict-preoperative, threshold, and incremental-performance analyses were performed.Results  The cohort included 14,566 cardiac-procedure records. After adjustment, RAR, NLR, SIRI, and SII were associated with higher 90-day and 1-year mortality, whereas HALP showed inverse associations and PLR was less consistent. Strict-preoperative analyses supported RAR, NLR, and SIRI. Spline analyses suggested graded nonlinear risk, and RAR provided the largest modest incremental performance gain.Conclusion  In patients undergoing cardiac procedures, inflammatory and immune-nutritional indices showed clinically coherent associations with mortality. RAR, NLR, and SIRI were the most consistent adverse markers, while HALP was protective. These indices provide modest adjunctive prognostic information and warrant prospective validation.
SN  - 1749-8090
ER  -