Abstract
<title>Abstract</title> <p>Objective To evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), serum creatinine and N-terminal pro-B-type natriuretic peptide (NT-proBNP), alone and in combination, in patients with heart failure with preserved ejection fraction (HFpEF) and qi deficiency and blood stasis syndrome. Methods This observational study included 154 patients with HFpEF and qi deficiency and blood stasis syndrome who were admitted between January 2023 and January 2025. Patients were classified into a MACE group (n = 51) and a non-MACE group (n = 103) according to whether major adverse cardiovascular events (MACE), defined as cardiovascular death, readmission for heart failure or acute myocardial infarction, occurred during 1 year of follow-up. Baseline clinical characteristics and laboratory indicators were compared between groups. Binary logistic regression was used to identify prognostic factors, and receiver operating characteristic (ROC) curve analysis was used to assess predictive performance. Results During follow-up, 51 of 154 patients developed MACE, corresponding to an incidence of 33.1%. The MACE group had higher traditional Chinese medicine syndrome scores, serum creatinine, NT-proBNP, NLR and PLR than the non-MACE group. In multivariable logistic regression, NLR was independently associated with MACE (OR, 1.322; 95% CI, 1.141–1.532; P < 0.001). The combined model incorporating NLR, PLR, serum creatinine and NT-proBNP showed better discrimination than any single indicator (AUC, 0.799; 95% CI, 0.701–0.898; P < 0.001), with a sensitivity of 0.719 and a specificity of 0.876 at the optimal cut-off. Conclusion NLR is an independent prognostic indicator for MACE in patients with HFpEF and qi deficiency and blood stasis syndrome. A combined model based on NLR, PLR, serum creatinine and NT-proBNP may improve early identification of high-risk patients and support individualized integrated Chinese and Western medical management.</p>