{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:09:12Z","timestamp":1779167352206,"version":"3.51.4"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic value of the C-reactive protein-to-lymphocyte ratio (CLR) in critical and inflammatory diseases is increasingly recognized. Nonetheless, its role in risk stratification for patients with congestive heart failure (CHF) who develop acute kidney injury (AKI) has not been thoroughly investigated. Research indicates that cardiorenal syndrome is mediated by a cytokine storm causing cardiac and renal injury, the extent of which can be quantified by the CLR and is significantly associated with adverse outcomes such as mortality and cardiovascular events. This study aims to elucidate the relationship between CLR and mortality in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Leveraging data from the MIMIC-IV database, we identified patients diagnosed with both CHF and AKI. We employed Cox models to gauge the link between CLR and near- and long-term (30-day\/365-day) all-cause mortality, supplemented by Kaplan-Meier analysis across CLR quartiles. The non-linear dynamics of this relationship were mapped with restricted cubic splines (RCS). The model\u2019s predictive performance was appraised using ROC curves, and potential effect modifiers were probed through comprehensive subgroup analyses to elucidate the interplay of key factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1605 patients, higher CLR quartiles were associated with significantly worse survival by Kaplan\u2013Meier analysis (log-rank P &amp;lt; 0.001). After full multivariable adjustment, the risk of 365-day mortality increased progressively across CLR quartiles (Q2: HR 1.96 [1.33\u20132.90]; Q3: 2.19 [1.49\u20133.21]; Q4: 3.78 [2.63\u20135.43]; P-trend &amp;lt; 0.001). Similar trends were observed for 30-day mortality (Q4: 4.32 [2.19\u20138.53]; P-trend &amp;lt; 0.001), although the HRs for Q2 and Q3 did not reach statistical significance. Fully adjusted RCS confirmed linear LnCLR\u2013mortality associations for 30\u2212day (P for nonlinearity = 0.352) and 365\u2212day outcomes (P for nonlinearity = 0.197). ROC analysis demonstrated fair discriminative ability of CLR for 30-day (AUC: 0.713) and 365-day mortality (AUC: 0.675). Subgroup analyses confirmed consistent prognostic effects (all P for interaction &amp;gt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CLR independently is associated with both short- and long-term mortality in CHF-AKI patients, supporting its clinical utility for risk stratification in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1746567","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:21:31Z","timestamp":1779164491000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of the C-reactive protein-to-lymphocyte ratio for prognosis in heart failure patients with acute kidney injury"],"prefix":"10.3389","volume":"17","author":[{"given":"Supei","family":"Yin","sequence":"first","affiliation":[{"name":"Nephrology Department, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengmei","family":"Shu","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongli","family":"Huang","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihui","family":"Quan","sequence":"additional","affiliation":[{"name":"Nephrology Department, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuai","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Intensive Care Unit, Zhuhai People\u2019s Hospital (The Affiliated Hospital of Beijing Institute of Technology, Zhuhai Clinical Medical College of Jinan University)","place":["Zhuhai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Wang","sequence":"additional","affiliation":[{"name":"Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1038\/s41569-019-0315-x","article-title":"Reappraising the role of inflammation in heart failure","volume":"41","author":"Adamo","year":"2020","journal-title":"Eur. Heart. J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1007\/s00011-023-01845-6","article-title":"Inflammation in heart failure: pathophysiology and therapeutic strategies","volume":"73","author":"Boulet","year":"2024","journal-title":"Inflamm. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s11897-024-00684-8","article-title":"Biomarkers of hemodynamic congestion in heart failure","volume":"21","author":"Brann","year":"2024","journal-title":"Curr. Heart. Fail. Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.ijcard.2023.03.024","article-title":"C-reactive protein and risk of incident heart failure in patients with cardiovascular disease","volume":"82","author":"Burger","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"741414","DOI":"10.3390\/biom15091220","article-title":"Neutrophil extracellular traps in sepsis: mechanisms and therapeutic implications","volume":"12","author":"Chen","year":"2021","journal-title":"Front. Immunol."},{"key":"B6","first-page":"492","article-title":"C-reactive protein-to-lymphocyte ratio as a prognostic marker in patients with chronic kidney disease: a retrospective cohort study","volume":"44","author":"Chen","year":"2022","journal-title":"Ren. Fail."},{"key":"B7","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1159\/000527198","article-title":"Acute and chronic cardiovascular consequencesof acute kidney injury: a systematic review and meta-analysis","volume":"13","author":"De Clercq","year":"2023","journal-title":"Cardiorenal.Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1590\/1806-9282.20220236","article-title":"C-reactive protein to lymphocyte count ratio is a promising novel marker in hepatitis c infection: the clear hep-c study","volume":"68","author":"Demirkol","year":"1992","journal-title":"Rev. Assoc. Med. Bras."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15222872","article-title":"C-Reactive Protein-to-Lymphocyte Ratio as a Prognostic Biomarker in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy: A Multicenter Study","volume":"15","author":"Dogan","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1038\/s41581-018-0052-0","article-title":"Global epidemiology and outcomes of acute kidney injury","volume":"14","author":"Hoste","year":"2018","journal-title":"Nat. Rev. Nephrol."},{"key":"B11","first-page":"734","article-title":"C-reactive protein-to-lymphocyte ratio predicts in-hospital cardiovascular events in patients with acute myocardial infarction","volume":"71","author":"Kalyoncuoglu","year":"2020","journal-title":"Angiology."},{"key":"B12","doi-asserted-by":"publisher","first-page":"760","DOI":"10.14744\/tjtes.2020.47973","article-title":"The role of C-reactive protein to lymphocyte ratio in the differentiation of acute and perforated appendicitis","volume":"26","author":"Koyuncu","year":"2020","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s40779-022-00422-y","article-title":"Sepsis-induced immunosuppression: mechanisms, diagnosis and current treatment options","volume":"9","author":"Liu","year":"2022","journal-title":"Mil. Med. Res."},{"key":"B14","first-page":"1","article-title":"Prognostic significance of the c-reactive protein-to-lymphocyte ratio in patients with sepsis: a retrospective cohort study","volume":"24","author":"Liu","year":"2020","journal-title":"Crit. Care"},{"key":"B15","first-page":"747","article-title":"The role of lymphocytes in sepsis: a narrative review","volume":"11","author":"Liu","year":"2020","journal-title":"Front. Immunol."},{"key":"B16","first-page":"4733","article-title":"C-reactive protein-to-lymphocyte ratio predicts mortality in patients with acute kidney injury after cardiac surgery","volume":"10","author":"Luo","year":"2021","journal-title":"J. Clin. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1038\/s41581-022-00616-6","article-title":"Epidemiology and risk of cardiovascular disease in populations with chronic kidney disease","volume":"18","author":"Matsushita","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.15829\/1560-4071-2023-5168","article-title":"2021 esc guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (esc)","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur. J. Heart. Fail."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3390\/biom13121803","article-title":"Neutrophil-to-lymphocyte ratio (nlr) in nsclc, gastrointestinal, and other solid tumors: immunotherapy and beyond","volume":"13","author":"Mosca","year":"2023","journal-title":"Biomolecules."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.72230","article-title":"Diagnostic performance of cystatin c in the early detection of diabetic kidney disease at the university of Nigeria teaching hospital, ituku-ozalla","volume":"16","author":"Nwanonenyi","year":"2024","journal-title":"Cureus."},{"key":"B21","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/j.kint.2019.05.026","article-title":"Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment","volume":"15","author":"Peerapornratana","year":"2019","journal-title":"Nat. Rev. Nephrol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e840","DOI":"10.1161\/cir.0000000000000664","article-title":"Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation."},{"key":"B23","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1038\/s41569-019-0326-7","article-title":"Neutrophils as regulators of cardiovascular inflammation","volume":"17","author":"Silvestre-Roig","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"B24","first-page":"423","article-title":"The prognostic value of c-reactive protein-to-lymphocyte ratio in patients with sepsis: a meta-analysis","volume":"13","author":"Tang","year":"2020","journal-title":"J. Inflamm. Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1186\/s12872-023-03572-6","article-title":"Neutrophil to lymphocyte ratio (nlr) prognostic effects on heart failure; a systematic review and meta-analysis","volume":"23","author":"Vakhshoori","year":"2023","journal-title":"BMC Cardiovasc. Disord."},{"key":"B26","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1186\/s12872-023-03316-6","article-title":"Association between neutrophil percentage-to-albumin ratio (npar), neutrophil-to-lymphocyte ratio (nlr), platelet-to-lymphocyte ratio (plr) and long-term mortality in community-dwelling adults with heart failure: evidence from us nhanes 2005-2016","volume":"23","author":"Wu","year":"2023","journal-title":"BMC Cardiovasc. Disord."},{"key":"B27","first-page":"2969","article-title":"Systemic immune-inflammation index predicts outcomes in patients with acute kidney injury: a retrospective cohort study","volume":"14","author":"Yang","year":"2021","journal-title":"J. Inflamm. Res."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1746567\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:21:33Z","timestamp":1779164493000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1746567\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":27,"alternative-id":["10.3389\/fphys.2026.1746567"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1746567","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"1746567"}}