Associations of the C-Reactive Protein−Albumin−Lymphocyte Index, Red Cell Distribution Width−Albumin Ratio, and Blood Urea Nitrogen−Albumin Ratio With All-Cause and Cardiovascular Mortality Among Adults With Preclinical Heart Failure

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2026-07-06 DOI:10.1002/clc.70401

Huifang Su, Xiandong Liu

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Abstract

Background

Preclinical heart failure (PHF) is an early stage in the heart failure continuum, yet practical indices for mortality risk assessment remain understudied.

Hypothesis

The C-reactive protein–albumin–lymphocyte index (CALLY), red cell distribution width–albumin ratio (RAR), and blood urea nitrogen–albumin ratio (BAR) are associated with mortality and provide additional predictive information among adults with PHF.

Methods

We analyzed adults aged ≥ 20 years with PHF from the National Health and Nutrition Examination Survey (NHANES) 1999–2010. PHF was defined by hypertension, diabetes, obesity, atherosclerotic cardiovascular disease, or prior myocardial infarction, without diagnosed heart failure. The indices were derived from baseline laboratory measurements and log-transformed. Mortality was ascertained through December 31, 2019. Associations were assessed using survey-weighted Cox models; nonlinearity, subgroup consistency across different PHF compositions, incremental predictive performance, and sensitivity analyses, including competing-risk models, were evaluated.

Results

Among 14 717 adults with PHF contributing 186 678.5 person-years, 3801 all-cause and 1226 cardiovascular deaths occurred. Per standard deviation increase, ln CALLY was associated with lower all-cause and cardiovascular mortality (HRs, 0.85 and 0.87), whereas ln RAR (HRs, 1.28 and 1.24) and ln BAR (HRs, 1.09 and 1.18) were associated with higher mortality. ln RAR showed the most consistent improvement in exploratory incremental predictive performance beyond the base model. The directions of association were broadly consistent across different PHF compositions, and the findings remained robust in sensitivity analyses.

Conclusions

CALLY, RAR, and BAR were independently associated with mortality in adults with PHF; RAR may improve mortality risk assessment.

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c反应蛋白-白蛋白淋巴细胞指数、红细胞分布宽度-白蛋白比和血尿素氮-白蛋白比与临床前心力衰竭成人全因死亡率和心血管死亡率的关系

背景：临床前心力衰竭（PHF）是心力衰竭连续体的早期阶段，但死亡率风险评估的实用指标仍未得到充分研究。假设：c反应蛋白-白蛋白淋巴细胞指数（CALLY）、红细胞分布宽度-白蛋白比（RAR）和血尿素氮-白蛋白比（BAR）与死亡率相关，并为成人PHF提供了额外的预测信息。方法：我们分析了1999-2010年国家健康与营养调查（NHANES）中年龄≥20岁的PHF患者。PHF的定义为高血压、糖尿病、肥胖、动脉粥样硬化性心血管疾病或既往心肌梗死，没有诊断出心力衰竭。这些指数是由实验室基线测量和对数变换得出的。截至2019年12月31日，死亡率已确定。使用调查加权Cox模型评估相关性；评估了非线性、不同PHF组成的亚群一致性、增量预测性能和敏感性分析（包括竞争风险模型）。结果：在14 717例成人PHF患者中，发生3801例全因死亡和1226例心血管死亡，共造成186 678.5人年。每增加一个标准差，ln CALLY与较低的全因死亡率和心血管死亡率相关（hr， 0.85和0.87），而ln RAR （hr， 1.28和1.24）和ln BAR （hr， 1.09和1.18）与较高的死亡率相关。ln RAR在探索性增量预测性能方面比基本模型表现出最一致的改善。关联方向在不同的PHF成分中大致一致，并且在敏感性分析中发现仍然是稳健的。结论：CALLY、RAR和BAR与成人PHF的死亡率独立相关；RAR可改善死亡率风险评估。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.