Prognostic utility of the inflammatory burden index for early mortality prediction in heart failure: a retrospective cohort study using the MIMIC-IV database

Background: Systemic inflammation a key factor in the progression of heart failure (HF). The inflammatory burden index (IBI) has prognostic value in different conditions; however, its impact on short-term mortality in patients with HF remains uncertain. This study aimed to assess the association between IBI and mortality risk in patients with HF. Methods: In this retrospective study, 600 patients with HF from the Medical Information Mart for Intensive Care IV database (2008–2022) were examined and divided into three groups according to the log-transformed IBI (LnIBI). The main outcome measured was 28-day mortality in the intensive care unit (ICU). We used multivariable Cox and logistic regression to assess the independent effect of LnIBI on mortality, after adjustment for confounders. The dose-response relationship was modeled using restricted cubic splines. Predictive performance was compared using receiver operating characteristic curves, and Kaplan-Meier analysis was used to assess survival differences;subgroup analyses were conducted. Results: The cohort included 342 males (57.0%), with a median age of 71.0 years. The 28-day ICU mortality rates were 17.2% (103/600). In adjusted models, higher LnIBI independently predicted an elevated risk (for example, 28-day mortality after ICU admission: Hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.09–1.41, p = 0.001; highest versus lowest tertile: HR: 1.99, 95% CI: 1.20–3.29, p = 0.008). Restricted cubic splines confirmed the linear dose-response relationship. LnIBI showed a superior area under the curve compared with C-reactive protein (CRP) for most endpoints (for example, 0.643 versus 0.595 for 28-day mortality after ICU admission, p = 0.032). Kaplan-Meier curves indicated poorer survival in the higher LnIBI tertiles (p < 0.05). Conclusions: Elevated IBI is independently associated with increased short-term mortality risk in critically ill patients with HF, outperforming CRP in predictive accuracy.

Heart failure; Inflammatory burden index; Mortality; MIMIC-IV; Prognosis

[1] Khan MS, Shahid I, Bennis A, Rakisheva A, Metra M, Butler J. Global epidemiology of heart failure. Nature Reviews Cardiology. 2024; 21: 717–734.

[2] Shahim B, Kapelios CJ, Savarese G, Lund LH. Global public health burden of heart failure: an updated review. Cardiac Failure Review. 2023; 9: e11.

[3] Murphy SP, Kakkar R, McCarthy CP, Januzzi JL III. Inflammation in heart failure: JACC state-of-the-art review. Journal of the American College of Cardiology. 2020; 75: 1324–1340.

[4] Savarese G, Lund LH. Global public health burden of heart failure. Cardiac Failure Review. 2017; 3: 7–11.

[5] Mohebi R, Liu Y, van Kimmenade R, Gaggin HK, Murphy SP, Januzzi JL III. Inflammation across universal definition of heart failure stages: the CASABLANCA study. European Journal of Heart Failure. 2023; 25: 152–160.

[6] Rajendiran KS, Ananthanarayanan RH, Satheesh S, Rajappa M. Elevated levels of serum sialic acid and high-sensitivity C-reactive protein: markers of systemic inflammation in patients with chronic heart failure. British Journal of Biomedical Science. 2014; 71: 29–32.

[7] Michou E, Wussler D, Belkin M, Simmen C, Strebel I, Nowak A, et al. Quantifying inflammation using interleukin-6 for improved phenotyping and risk stratification in acute heart failure. European Journal of Heart Failure. 2023; 25: 174–184.

[8] Mo J, Liu X, Zhang H, Liu Z, Luo T, Yang X, et al. Inflammatory burden index and one-year clinical outcomes in large artery atherosclerosis ischemic stroke: a multicenter prospective study. European Journal of Neurology. 2025; 32: e70242.

[9] Yang Z, Wang L, Hong B, He Z, Zhang Q, Shen T, et al. Inflammatory burden index as a predictor of in-hospital mortality in patients with severe fever with thrombocytopenia syndrome. Journal of Medical Virology. 2025; 97: e70225.

[10] Huang JB, Zhou ZY, Lu J, Zhu JY, Lai B, Mao SX, et al. Inflammatory burden index as a prognostic marker in patients with advanced gastric cancer treated with neoadjuvant chemotherapy and immunotherapy. Frontiers in Immunology. 2025; 15: 1471399.

[11] Zhong Z, Fan M, Lv L, Long Q, Li K, Xu P. Inflammatory burden index as a predictor of mortality in septic patients: a retrospective study using the MIMIC-IV database. BMC Infectious Diseases. 2025; 25: 552.

[12] Yun LX, Huang WZ, He C, Huang Y, Yang HF, Su Q, et al. Association between inflammatory burden index and risk of heart failure: evidence from NHANES 2003–2017. BMC Cardiovascular Disorders. 2025; 25: 318.

[13] Ge W, Zhang Y, Ge S, Chen M, Xu Y. Predictive value of IBI for acute kidney injury with contrast after PCI in patients with ST-segment elevation myocardial infarction. Frontiers in Cardiovascular Medicine. 2025; 12: 1562731.

[14] Joury A, Ventura H, Krim SR. Biomarkers in heart failure: relevance in the clinical practice. International Journal of Cardiology. 2022; 363: 196–201.

[15] Sarhene M, Wang Y, Wei J, Huang Y, Li M, Li L, et al. Biomarkers in heart failure: the past, current and future. Heart Failure Reviews. 2019; 24: 867–903.

[16] Wang Q, An Y, Wang H, Zhang N, Deng S. The clinical significance of changes in cTnT, CRP and NT-proBNP levels in patients with heart failure. American Journal of Translational Research. 2021; 13: 2947–2954.

[17] Yu F, Peng J. Association between inflammatory burden index and cardiovascular disease in adult Americans: evidence from NHANES 2005–2010. Heliyon. 2024; 10: e38273.

[18] Zhu N, Lin S, Wang L, Kong X, Huang W, Cao C. Elevated inflammatory burden index increases mortality in adults with chronic inflammatory airway diseases: a nationwide cohort study. BMC Pulmonary Medicine. 2024; 24: 399.

[19] Xie H, Ruan G, Wei L, Deng L, Zhang Q, Ge Y, et al. The inflammatory burden index is a superior systemic inflammation biomarker for the prognosis of non-small cell lung cancer. Journal of Cachexia, Sarcopenia and Muscle. 2023; 14: 869–878.

[20] Arvunescu AM, Ionescu RF, Cretoiu SM, Dumitrescu SI, Zaharia O, Nanea IT. Inflammation in heart failure-future perspectives. Journal of Clinical Medicine. 2023; 12: 7738.

[21] Pellicori P, Zhang J, Cuthbert J, Urbinati A, Shah P, Kazmi S, et al. High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death. Cardiovascular Research. 2020; 116: 91–100.

[22] Ang SP, Chia JE, Jaiswal V, Hanif M, Iglesias J. Prognostic value of neutrophil-to-lymphocyte ratio in patients with acute decompensated heart failure: a meta-analysis. Journal of Clinical Medicine. 2024; 13: 1212.

[23] Erdélyi L, Trásy D. CRRT is more than just continuous renal replacement therapy. Pharmaceuticals. 2024; 17: 1571.