Integrating inflammatory and nutritional markers: the prognostic value of the platelet-to-lymphocyte/albumin ratio for one-year all-cause mortality in patients undergoing transcatheter aortic valve implantation

Background: Previous studies have highlighted the role of inflammatory and nutritional markers in predicting outcomes in cardiovascular diseases. However, to our knowledge, no study has explored the impact of the combination of these two aspects on outcome of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to assess the predictive value of the pre-procedural platelet-to-lymphocyte ratio (PLR)/albumin ratio on one-year mortality in this population METHODS: This retrospective observational study screened 867 patients who underwent TAVI between December 2018 and September 2023 at our tertiary center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. After excluding patients with systemic inflammatory or autoimmune diseases (223), cancer (257), acute or chronic infections (22), and those with missing data (77), the final cohort comprised 288 patients. PLR and albumin levels were calculated from pre-procedural blood samples, and the PLR/albumin ratio was subsequently derived. The prognostic discriminatory capacity and cutoff value of the PLR/albumin ratio were assessed using multivariate Cox regression and ROC analysis, respectively. Results: Individually both PLR and albumin were confirmed as independent predictors of post-TAVI 1-year mortality (odds ratios: 1.01 and 0.83, respectively), but their association with outcome was sensibly increased when considered together as PLR/albumin ratio (odds ratio: 1.33 [95% CI: 1.1-1.6, P=0.007]). In particular, PLR/albumin ratio >4.69 showed the best predictive capacity (AUC 0.69, sensitivity 56.25%, specificity 83.27%) for patients at higher risk of mortality in the first year after TAVI. No other clinical covariate demonstrated such comparable outcome predictive strength. Conclusions: A high PLR/albumin ratio resulted as independent one-year mortality predictor in patients undergoing TAVI procedure. The proposed combination of inflammatory and nutritional markers outperformed the value of single parameters. Its integration into pre-procedural TAVI work-out could be represent a further improvement of individualized risk stratification.