Aims We aim to investigate the correlation between high levels of the systemic immune‐inflammation index (SII) and long‐term mortality and major cardiovascular adverse events in advanced chronic heart failure patients with renal dysfunction. Methods and results Seven hundred seventeen advanced chronic heart failure patients with renal dysfunction, who visited the First affiliated hospital of Zhengzhou University from September 2019 to December 2020, were included. All‐cause mortalities (ACM) were selected as primary endpoints and major cardiovascular adverse events (MACEs) as the secondary endpoints. Based on the receiver operating characteristic (ROC) curve and the Youden index, the optimal cut‐off values of SII for ACM and MACEs were 1228 and 1406. In the group where ACM were the primary endpoint, patients were categorized into the low‐SII group ( n = 479) and the high‐SII group ( n = 238). Patients in the group using MACEs as the secondary endpoint were also categorized into the low‐SII groups ( n = 514) and the high‐SII groups ( n = 203). Univariate and multivariate COX regression were used to screen the independent predictors for ACM and MACEs, revealing the relationship between SII levels and endpoints. According to the univariate COX analysis, SII was the risk factor (hazard ratio [HR] = 2.144, 95% confidence interval [CI]: 1.565–2.938, P < 0.001) for the ACM subgroup. It was also the risk factor (HR = 1.625, CI: 1.261–2.905, P < 0.001) for the MACEs subgroup. Multivariate COX regression analysis indicated that the occurrence of ACM and MACEs in high‐level SII and low‐level SII patients had statistical differences. The incidence of ACM increased by 70.3% (HR = 1.703; 95% CI: 1.200–2.337; P = 0.002) in patients of the high SII level group, the incidence of MACEs increased by 58.3% (HR = 1.583, 95% CI: 1.213–2.065, P = 0.001). Kaplan–Meier (K‐M) survival analysis further suggested that patients with a high SII level had an increased risk of having ACM (log‐rank P < 0.001) and MACEs (log‐rank P < 0.001) within 30 months. SII could be considered as a novel predictor of the occurrence of ACM and MACEs for patients with advanced chronic heart failure and renal dysfunction. Conclusions This study suggested that SII is a novel independent predictor of mortality in advanced chronic heart failure patients with renal dysfunction, and it should be considered in current clinical management.
Heart failure is a complex clinical syndrome caused by the progression to severe stages of various cardiac diseases, characterized by high morbidity and mortality. With the increasing aging of the population and the poor control of high-risk factors for heart failure such as hypertension and diabetes, the incidence of heart failure remains high. Therefore, there is widespread global attention regarding the various treatments for heart failure. Currently, pharmacological therapy, associated device therapy, interventional therapy, and end-stage surgical related therapy are the main clinical treatments for heart failure. Heart failure treatment is gradually evolving to be more precise, safe, and effective, as traditional therapies can no longer match clinical needs. A number of cutting-edge research studies are being conducted on the treatment of heart failure, based on the different pathogenesis and causes of heart failure, to treat patients with heart failure in a multifaceted and integrated way. This article summarizes the current clinical treatment of heart failure and the latest therapeutic advances in heart failure in current research to further promote the standardized management and treatment of heart failure and improve patient prognosis.
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