Reporter brief
Higher neutrophil-to-lymphocyte ratio associated with worse heart failure outcomes in RCT of 9706 patients, unmodified by empagliflozin.
What happened
This post-hoc analysis of the EMPEROR-Pooled RCT examined 9706 heart failure patients randomised to empagliflozin or placebo, measuring baseline neutrophil-to-lymphocyte ratio (NLR) and clinical outcomes. Patients in the highest NLR quintile had higher rates of heart failure hospitalisation or cardiovascular death (27.3% vs 14.9%, adjusted HR 1.44) compared to the lowest quintile. Empagliflozin's beneficial effects on primary and secondary outcomes were consistent across all NLR quintiles, and the drug did not reduce elevated NLR during follow-up.
Why it matters
Assessment pending; this report does not establish a change in evidence.
What it does NOT prove
- Limitations have not been recorded; consult the primary source.
Study design and sample
Rct; Human.
Patients with chronic heart failure (CHF), combining EMPEROR-Reduced and EMPEROR-Preserved trials
- Design
- Rct
- Sample
- 9,706
- Journal
- ESC Heart Failure
- Published
- Sep 18, 2026
Effect size
Adjusted hazard ratio 1.44 (1.16-1.80) for primary outcome comparing highest vs lowest NLR quintile; 14.9% versus 27.3% events
Caveats
- Assessment: Superseded.
- Only the source material recorded on this evidence page was assessed.
Conflicts and funding
Not recorded.
Previous evidence
See the SGLT2 inhibitors timeline and recorded assessment for prior evidence.
Primary source
Cancel Death charts and briefs may be reproduced editorially with attribution to CancelDeath.com. This brief is generated from the primary recorded source facts and assessment. Its review status is shown below; verify quotations against the paper before publication.