Higher neutrophil-to-lymphocyte ratio associated with worse heart failure outcomes in RCT of 9706 patients, unmodified by empagliflozin.
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.
What this changes
The finding has not established an approved change to our evidence assessment.
Source date: Sep 18, 2026 · Discovered: Sep 19, 2026 · Assessed: — · Research update
What it does not prove
- Limitations have not yet been verified. Read the primary source.
Extracted from supplied source material; model confidence is not a measured probability of correctness.
Study details
- Design
- Rct
- Sample size
- 9,706
- Duration
- —
- Population
- Patients with chronic heart failure (CHF), combining EMPEROR-Reduced and EMPEROR-Preserved trials
- Primary outcome
- Time to first heart failure hospitalisation or cardiovascular death
- 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
- Significance
- Significant
- Journal
- ESC Heart Failure
- Published
- Sep 18, 2026
Sources
Primary source
- ESC heart failure ↗Peer reviewed
Assessment history
9/24/2026 · SUPERSEDED: Source updated; assessment withdrawn pending review.
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