Abstract
Background
Pulmonary hypertension (PH), a progressive multisystemic disorder characterized by right ventricular failure and hepatic congestion, significantly alters platelet dynamics and liver function. This study evaluated the ability of the platelet-albumin-bilirubin index (PALBI), a marker of the hepatic-cardiac axis, to discriminate between PH patients and healthy individuals and to predict 360-day all-cause mortality and heart failure-related hospitalizations (HFH).Methods and results
This retrospective study included 3,432 individuals (1,520 PH patients, identified based on high-risk echocardiographic parameters to reflect real-world clinical practice). PH patients had higher PALBI scores than healthy controls (-2.08 vs. -2.50; P=0.001). For disease discrimination, PALBI had an area under the curve (AUC) of 0.748 (cut-off -2.27; sensitivity 77%, specificity 80%), outperforming the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein. In the PH cohort (21.5% mortality; 36.4% HFH), PALBI was an independent predictor of 360-day mortality and HFH (odds ratios 1.24 [P=0.003] and 1.18 [P=0.006], respectively). PALBI (cut-off -1.98) outperformed estimated glomerular filtration rate, age, and NLR in predicting mortality; when combined with N-terminal pro B-type natriuretic peptide, mortality prediction accuracy rose by 15.6%. Kaplan-Meier analysis confirmed a significant stepwise decline in survival across PALBI tertiles (PConclusions
PALBI is a robust, cost-effective prognostic tool for PH. It independently predicts short-term mortality and HFH, offering enhanced risk stratification for high-risk patients in clinical settings.