The Scottish inflammatory prognostic score: A novel biomarker for predicting in-hospital mortality in acute heart failure with reduced ejection fraction.

Background: Acute heart failure with reduced ejection fraction (AHF) remains a leading cause of ED visits, hospitalizations, and in-hospital mortality.

Objectives: To evaluate the prognostic utility of the Scottish Inflammatory Prognostic Score (SIPS) in patients with AHF.

Methods: This retrospective study analyzed 508 patients admitted with AHF between November 2022 and November 2024. The SIPS was calculated based on albumin and neutrophil levels. Clinical and laboratory parameters were compared between survivors and non-survivors to identify predictors of all-cause in-hospital mortality.

Results: At a median follow-up of 10 days (range 4-28), 63 patients (12.4 %) died. The mean age of the study population was 63 years, with non-survivors being older on average. Multivariable Cox proportional regression analysis revealed high SIPS values (HR: 2.335, 95 % CI: 1.044 - 5.221, p = 0.039), advanced age, elevated NT-pro-BNP levels, chronic renal failure, and low serum sodium as independent predictors of in-hospital mortality. When patients were categorized by SIPS scores of 0, 1, and 2, the associated mortality rates were 5.1 %, 14.0 %, and 46.0 %, respectively (p < 0.001). Additionally, ROC curve analysis indicated that a SIPS threshold of 0.5 effectively predicted in-hospital mortality, demonstrating a sensitivity of 77 % and a specificity of 58 % (95 % CI: 0.661-0.803, p < 0.001).

Conclusions: This study is the first to analyze the association between SIPS and in-hospital mortality in patients with AHF. Integrating SIPS with other established risk factors may help improve the identification of high-risk AHF patients who could benefit from closer monitoring and intensified therapy, though further validation is warranted.