Association of the Naples prognostic score with all-cause and cardiovascular mortality in U.S. patients with heart failure: a retrospective cohort study using NHANES 2001–2018

BACKGROUND: Naples Prognostic Score (NPS) predicts mortality risk in heart failure (HF). METHODS AND RESULTS: This retrospective cohort study utilized data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES), including 1,111 adults with HF. The NPS was calculated based on serum albumin (SA), total cholesterol (TC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Mortality outcomes were ascertained through linkage with the National Death Index (NDI). Associations between NPS and all-cause mortality (ACM) and cardiovascular mortality (CVM) were evaluated using survey-weighted Cox proportional hazards models and Kaplan-Meier (KM) analyses. Subgroup and sensitivity analyses were performed to assess the robustness of the findings. Over a median follow-up of 70 months (interquartile range [IQR], 36-114 months), 545 ACM and 202 CVM cases were documented. Compared with participants with an NPS of 0, those in the high-risk group (NPS: 3-4) had significantly increased risks of mortality, with adjusted hazard ratios (HRs) of 2.53 (95% confidence interval [CI], 1.38-4.63; P < 0.01) for ACM and 2.62 (95% CI, 1.20-5.74; P < 0.05) for CVM. These associations remained consistent across subgroup and sensitivity analyses, supporting the robustness of the results. CONCLUSION: A higher NPS was independently associated with increased risks of ACM and CVM among U.S. adults with HF. These findings suggest that NPS may serve as a useful prognostic marker; however, further validation in prospective clinical cohorts is warranted.