Introduction: T eh neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) are novel proposed biomarkers of worse prognosis in patients with heart failure (HF). The impact of atrial fibrillation (AF) on their mortality predictive value is yet unknown.

Obiectiv: The aim of this study was to evaluate the pro-gnostic value of NLR, LMR, and PLR in patients with HF and AF as compared with NT-proBNP.

Methods: Our study included the medical records of pacients with HF with either sinus rhythm (SR) or AF admitted to our clinic from January 2011 to Decem-ber 2014. We excluded the patients with malignancies, hematologic diseases, infections, inflamatory diseases, acute coronary syndromes and pulmonary embolisms. Survival rate was assessed in August 2018. Cut-off va-lues were calculated using the Youden index associated criterion.

Results: We examined 1164 HF patients, 568 (48.8%) with AF and 596 (51.2%) in SR, with a mean age of 72.19 ± 10.47. Mortality rate was 58.44% during a me-dian follow-up time of 5.5 (4 -7) years. In AF patients, LMR predicted all-cause long-term mortality with an AUC of 0.669 (95% CI 0.627-0.708, p<0.001) and a cut-off value of ≤ 2.4, NLR with an AUC of 0.643 ( 95%CI 0.601-0.683, p<0.001) and a cut-off value of > 2.8 and PLR with an AUC of 0.611 ( 95% CI 0.569-0.653, p<0.001) and a cut-off value of >149.6In SR patients, LMR predicted all-cause long-term mortality with an AUC of 0.661 (95% CI 0.611-0.710, p<0.001) and a cut-off value of <2.1, NLR with an AUC of 0.700 (95% CI 0.650-0.746, p<0.001) and a cut-off value of >2.7 and PLR with an AUC of 0.600 (95% CI 0.548-0.651, p<0.01) and a cut-off value of >169.7. Both, in patients with SR as well as AF, in multiple regression analysis, after adjusting for age and sex, alongside NT-proBNP and left ventricular ejection fraction, LMR and NLR were independent predictors of mortality, in both SR and AF patients while PLR was independent predictor only in patients with AF.

Conclusions: LMR, PLR and NLR are independent predictors of mortality in HF with AF. In HF in SR, only LMR and NLR and independent mortality predictors. Cut-off values for each ratio are similar in AF and SR.