{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:56:49Z","timestamp":1790769409150,"version":"4.1.0"},"reference-count":19,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: This study evaluated the association between admission Naples Prognostic Score (NPS) and in-hospital mortality in patients with clinical features consistent with type 2 cardiorenal syndrome (CRS-2). Methods: This retrospective, single-center study included 101 adults hospitalized for decompensated heart failure at Sakarya University Training and Research Hospital between June 2021 and August 2024. CRS-2 classification relied on nephrologist review of historical records. Admission NPS combined albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. NPS was analyzed primarily as a continuous score using univariable and multivariable Firth penalized logistic regression with profile penalized-likelihood confidence intervals. Low (0\u20132) versus high (3\u20134) NPS comparisons were exploratory; no patient scored 0. Results: Overall, 26 patients (25.7%) died. Mortality was higher in the high-NPS than the low-NPS group (24\/52 [46.2%] versus 2\/49 [4.1%]; p &lt; 0.001). After adjustment for age, New York Heart Association (NYHA) functional class, and left ventricular ejection fraction (LVEF), the odds ratio per one-point NPS increase was 3.42 (95% confidence interval [CI], 1.76\u20137.77; p &lt; 0.001). The area under the receiver operating characteristic curve was 0.825 (percentile bootstrap 95% CI, 0.744\u20130.896). At the established NPS \u2265 3 category boundary, sensitivity was 92.3% (95% CI, 75.9\u201397.9%) and specificity was 62.7% (95% CI, 51.4\u201372.7%). Performance was estimated within the same cohort without optimism correction or external validation. Conclusions: Higher admission NPS was associated with in-hospital mortality after adjustment for age, NYHA class, and LVEF. These exploratory findings require external validation and assessment of incremental predictive value and clinical utility.<\/jats:p>","DOI":"10.3390\/diagnostics16193185","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:59:25Z","timestamp":1790765965000},"page":"3185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between the Naples Prognostic Score and In-Hospital Mortality in Patients with Type 2 Cardiorenal Syndrome: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-4767","authenticated-orcid":false,"given":"Eren","family":"Eynel","sequence":"first","affiliation":[{"name":"Department of Nephrology, Gazi Ya\u015fargil Training and Research Hospital, 21070 Diyarbak\u0131r, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8459-3418","authenticated-orcid":false,"given":"Emre","family":"Eynel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4535-7367","authenticated-orcid":false,"given":"Yusuf","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/eurheartj\/ehp507","article-title":"Cardio-renal syndromes: Report from the consensus conference of the Acute Dialysis Quality Initiative","volume":"31","author":"Ronco","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal syndrome: Classification, pathophysiology, diagnosis, and treatment strategies: A scientific statement from the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000349968","article-title":"Pathophysiology of cardiorenal syndrome type 2 in stable chronic heart failure: Workgroup statements from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)","volume":"182","author":"Cruz","year":"2013","journal-title":"Contrib. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1093\/ajcn\/nqaa311","article-title":"The impact of malnutrition on short-term morbidity and mortality in ambulatory patients with heart failure","volume":"113","author":"Sze","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1097\/DCR.0000000000000961","article-title":"Naples Prognostic Score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer","volume":"60","author":"Galizia","year":"2017","journal-title":"Dis. Colon Rectum"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2217\/bmm-2022-0689","article-title":"Impact of Naples Prognostic Score on midterm all-cause mortality in patients with decompensated heart failure","volume":"17","author":"Erdogan","year":"2023","journal-title":"Biomark. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2442536","DOI":"10.1080\/07853890.2024.2442536","article-title":"The importance of Naples prognostic score in predicting long-term mortality in heart failure patients","volume":"57","author":"Aydemir","year":"2025","journal-title":"Ann. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jacc.2008.05.068","article-title":"Importance of venous congestion for worsening of renal function in advanced decompensated heart failure","volume":"53","author":"Mullens","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16673","DOI":"10.1038\/s41598-022-20985-z","article-title":"Association of malnutrition with renal dysfunction and clinical outcome in patients with heart failure","volume":"12","author":"Otaki","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Vakhshoori, M., Nemati, S., Sabouhi, S., Yavari, B., Shakarami, M., Bondariyan, N., Emami, S.A., and Shafie, D. (2023). Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03572-6"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ang, S.P., Chia, J.E., Jaiswal, V., Hanif, M., and Iglesias, J. (2024). Prognostic value of neutrophil-to-lymphocyte ratio in patients with acute decompensated heart failure: A meta-analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051212"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ncp.10588","article-title":"The use of visceral proteins as nutrition markers: An ASPEN position paper","volume":"36","author":"Evans","year":"2021","journal-title":"Nutr. Clin. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1177\/00033197231151559","article-title":"Impact of Naples Prognostic Score at admission on in-hospital and follow-up outcomes among patients with ST-segment elevation myocardial infarction","volume":"74","author":"Erdogan","year":"2023","journal-title":"Angiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1177\/00033197231170982","article-title":"Evaluation of Naples Score for long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention","volume":"75","author":"Akbulut","year":"2024","journal-title":"Angiology"},{"key":"ref_15","first-page":"219","article-title":"Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis","volume":"103","author":"Demirci","year":"2024","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1177\/00033197241285970","article-title":"Predictive value of the Naples Prognostic Score for cardiovascular outcomes in patients with chronic kidney disease receiving percutaneous coronary intervention","volume":"77","author":"Zhang","year":"2026","journal-title":"Angiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8640","DOI":"10.1038\/s41598-026-43811-2","article-title":"Predictive value of the Naples Prognostic Score for rapid kidney function decline in stage 3\u20134 CKD: A multicenter study","volume":"16","author":"Inci","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models: A framework for traditional and novel measures","volume":"21","author":"Steyerberg","year":"2010","journal-title":"Epidemiology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3185\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:12:40Z","timestamp":1790766760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":19,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193185"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193185","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}