Laboratory-derived inflammatory-nutritional exploratory phenogroups and their associations with functional limitation and 30-day same-center all-cause unplanned readmission in patients with heart failure.

Authors

Yilian Zhang, Xu Zhang, Hongbin Song, Qiyu Hu, Jingzhu Nan

Published in

Frontiers in nutrition. Volume 13. Pages 1985953. Epub Oct 09, 2026.

Abstract

Heart failure (HF) is characterized by marked clinical heterogeneity, while conventional left ventricular ejection fraction (LVEF)-based classification may not fully capture systemic inflammatory, nutritional, hematologic, and cardiorenal abnormalities. We aimed to identify laboratory-derived inflammatory-nutritional exploratory phenogroups in hospitalized patients with HF and evaluate their associations with functional limitation and 30-day same-center all-cause unplanned readmission.
This single-center retrospective cohort included 1,588 hospitalized patients with HF, of whom 1,455 with complete data for 15 prespecified clustering variables were included in the primary analysis. K-means, Gaussian mixture models, and DBSCAN were compared, and K-means with K = 3 was selected based on internal separation, stability, cluster size, and clinical interpretability, with K = 2 used as a sensitivity analysis. Severe functional limitation was defined as NYHA class III-IV, and 30-day same-center all-cause unplanned readmission was evaluated as the short-term clinical outcome. Multivariable logistic regression with HC3 robust standard errors was used to assess these associations, with multiple-imputation and median-imputation sensitivity analyses conducted in the full cohort.
Three phenogroups were identified: an inflammatory-cardiorenal-nutritional vulnerability phenotype, an anemia-immune dysregulation phenotype, and a relatively preserved laboratory phenotype. LVEF was similar across groups, whereas severe functional limitation and 30-day same-center all-cause unplanned readmission differed significantly. After enhanced adjustment, compared with Cluster 3, the odds ratios for severe functional limitation were 3.814 and 5.594 for Clusters 1 and 2, respectively, and the corresponding odds ratios for 30-day same-center all-cause unplanned readmission were 1.966 and 2.616. Higher quartiles of both ALI and PNI were associated with lower odds of severe functional limitation; higher ALI quartiles and the highest PNI quartile were associated with lower odds of 30-day same-center all-cause unplanned readmission.
Routine admission laboratory measurements identified three exploratory HF phenogroups with distinct inflammatory, nutritional, hematologic, and cardiorenal profiles. After adjustment for continuous LVEF and NT-proBNP, the two vulnerable phenogroups remained associated with severe functional limitation and 30-day same-center all-cause unplanned readmission, with directionally consistent findings in the full-cohort and K = 2 sensitivity analyses. ALI and PNI reflect laboratory-derived inflammatory-nutritional vulnerability but cannot replace formal nutritional assessment or establish incremental predictive value. These findings remain exploratory and require validation in prospective multicenter cohorts.

PMID:
42920529
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.

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