Background: Neutrophils and albumin had been shown to be independent predictors of mortality from various diseases. Purpose of this study was to investigate the effect of neutrophil-to-albumin ratio (NPAR) as an independent predictor of mortality in heart failure (HF) patients. Methods: Data were extracted from Medical Information Mart for Intensive Care-III database. Primary outcome was 30-day mortality, secondary outcomes were in-hospital, 90-day, 365-day mortality, length of stay (LOS) in hospital. Cox proportional hazards regression model and receiver operating characteristic (ROC) curve analysis and Pearson correlation analysis were used. Results:The HR (95% CI) values of the mid-tertile and the upper tertile were 1.27 (1.01 to 1.59) and 2.29 (1.87 to 2.81) in 30-day mortality compared with the reference. The trend continued after adjusted for demographic and clinical variables. In the secondary outcomes were the same trends. The data of the Second Affiliated Hospital of Wenzhou Medical University showed the correlation coefficient between hospital LOS with NPAR. Conclusion: NPAR was an independent factor of mortality in HF patients, which was correlated with hospital LOS. Our results need to be verified by prospective studies.

Metformin (Met) is a major widely used oral glucose lowering drug for the treatment of type 2 diabetes. It is reported that metformin could regulate autophagy in various diseases of cardiovascular system including in I/R injury, diabetic cardiomyopathy and heart failure. Autophagy plays a controversial role in ischemia/reperfusion (I/R) injury, and this research was performed to explore the cardioprotective effect of Met on I/R injury and discuss the underlying mechanism of autophagy in it. In vivo and in vitro, Met exerted cardioprotection function of decreasing myocardial inflammation and apoptosis with a decrease in the level of autophagy. Moreover, Met significantly inhibited autophagosome formation and restore the impairment of autophagosome processing, which lead to cardioprotection effect of Met. Akt was up-regulated in Met-treated I/R hearts and miransertib, a pan-AKT inhibitor, was able to reverse the alleviating autophagy effect of Met. We demonstrate that Met protects cardiomyocytes from I/R-induced apoptosis and inflammation through down regulation of autophagy mediated by Akt signaling pathway.

BackgroundSystemic inflammation is closely associated with the development and progression of heart failure (HF), increasing vulnerability to thromboembolic events. This retrospective cohort study assessed the potential of the fibrinogen‐to‐albumin ratio (FAR), a new inflammatory biomarker, as a prognostic indicator for HF risk.MethodsOne thousand one hundred and sixty six women and 826 men with a mean age of 70.70 ± 13.98 years were extracted from the Medical Information Mart for Intensive Care‐IV (MIMIC‐IV v2.0) database. Additionally, a second cohort was obtained, including 309 patients from the Second Affiliated Hospital of Wenzhou Medical University. The relationship between FAR and the prognosis of HF was evaluated using multivariate analysis, propensity score‐matched analysis, and subgroup analysis.ResultsFibrinogen‐to‐albumin ratio was an independent risk factor for 90‐day all‐cause mortality (hazard ratio: 1.19; 95% confidence interval (CI): 1.01–1.40), 1‐year all‐cause mortality (hazard ratio: 1.23; 95% confidence interval: 1.06–1.41), and length of hospital stay (LOS) (β: 1.52; 95% CI: 0.67–2.37) in the MIMIC‐IV dataset, even after adjusting for potential covariates. These findings were verified in the second cohort (β: 1.82; 95% CI: 0.33–3.31) and persisted after propensity score‐matching and subgroup analysis. FAR was positively correlated with C‐reactive protein, NT‐proBNP, and Padua score. The correlation between FAR and NT‐proBNP (R = .3026) was higher than with fibrinogen (R = .2576), albumin (R = −.1822), platelet‐to‐albumin ratio (R = .1170), and platelet‐to‐lymphocyte ratio (R = .1878) (ps < .05).ConclusionsFibrinogen‐to‐albumin ratio is an independent risk prognostic factor for 90‐day, 1‐year all‐cause mortality and LOS among HF patients. Inflammation and prothrombotic state may underlie the relationship between FAR and poor prognosis in HF.

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