Inflammatory prognostic index predicts late mortality after surgical aortic valve replacement

Abstract

Objective

This study aimed to investigate the prognostic value of the preoperative Inflammatory Prognostic Index (IPI) in predicting late mortality in patients undergoing isolated surgical aortic valve replacement (AVR).

Methods

A retrospective, single-center cohort of 400 patients who underwent elective, isolated surgical AVR between 2015 and 2023 was analyzed. The IPI was calculated using the formula: C-reactive protein (CRP) × neutrophil-to-lymphocyte ratio (NLR) / albumin. Patients were stratified into low- and high-IPI groups based on an optimal cut-off value of 0.2588 determined via ROC analysis. Clinical characteristics, operative data, and outcomes were compared. Cox proportional hazards regression was used to identify independent predictors of late mortality.

Results

Patients with high IPI scores (≥0.2588) had significantly increased late mortality compared to those with low IPI (<0.2588) (10.3% vs 2.3%, p < .001). High IPI was associated with elevated CRP and neutrophils, and reduced albumin and lymphocytes. In univariate analysis, age, bioprosthesis use, and high IPI were significantly associated with late mortality. However, in multivariate analysis, only high IPI remained an independent predictor (HR = 3.405, 95% CI: 1.289–8.996, p = .013). Kaplan–Meier survival analysis confirmed lower long-term survival in the high-IPI group (log-rank p < .001).

Conclusion

Preoperative IPI is a simple, accessible, and independent predictor of late mortality after surgical AVR. Integrating IPI into preoperative risk assessment may improve long-term prognostic stratification and guide perioperative management.