Therefore, in this retrospective study, we sought to investigate the association between NLR, PLR and 30-day mortality in a cohort of patients hospitalized for an episode of ADHF. Recently, NLR and PLR have been proposed as reliable indicators of immune activation, inflammation and oxidative stress injury, and their measurement has been considered a valuable tool for predicting mortality in patients with cardiovascular disease ( 21, 22). In acute decompensation, the innate immune response promotes both pro-inflammatory cytokines release and oxidative stress injury, which impair vascular homeostasis and withstand fluid retention ( 9, 17, 20). Evidence collected during the last 30 years from in vitro and in vivo studies have helped to elucidate the different immune mechanisms that contribute to triggering systolic dysfunction and progressive alteration of heart structure in patients with chronic HF ( 5, 19). The role of inflammation in HF ( 15, 16), and more specifically its contribution to episodes of acute decompensation is still largely debated ( 17, 18). Among these, both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) ratio were proven to be useful prognostic biomarkers in cardiovascular disease ( 12, 13), and have recently been proposed as potentially useful indicators of immune response activation in ADHF ( 14). The prognostic value of many alleged biomarkers has been extensively studied over the past decade ( 10, 11). Along with the potential recognition of innovative therapeutic targets ( 7), the elucidation of underlying mechanisms behind HF may lead the way to identify a set of putative biomarkers, which may be used for more reliably predicting patient outcomes ( 8, 9, 10). The most appropriate clinical management of HF entails a deep understanding of the many factors involved in development of ADHF ( 6). HF is a complex and multifaceted syndrome, attributable to various pathological mechanisms which all synergistically contribute to generating structural or functional abnormalities, ultimately culminating in an imbalance between cardiac capacity and peripheral oxygen demand ( 5). Although much progress has been made in diagnosis and management of heart failure (HF) over the past few decades, hospitalizations for acute decompensated heart failure (ADHF) still remain highly frequent and are often associated with medium- and long-term mortality ( 1, 2, 3, 4).
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