Objective To investigate the levels of serum ferritin (SF) and N-terminal pro-brain natriuretic peptide to estimated glomerular filtration rate ratio (NT-proBNP/eGFR) in patients with chronic heart failure (CHF) and their impacts and predictive values for the risk of acute exacerbation of the disease.

Methods A total of 203 CHF patients were prospectively and consecutively enrolled as the study subjects and followed up for 3 months. According to whether acute exacerbation of the disease occurred, they were divided into occurrence group and non-occurrence group. The baseline data and SF and NT-proBNP/eGFR levels were compared between the two groups, and the SF level and NT-proBNP/eGFR were also compared between patients with and without anemia. Logistic regression analysis was used to screen for independent influencing factors for the risk of acute exacerbation of CHF. The predictive efficacies of different schemes for the risk of acute exacerbation of CHF were evaluated by the receiver operating characteristic (ROC) curve and its area under the curve (AUC).

Results The proportion of patients with a New York Heart Association (NYHA) cardiac function classification of grade Ⅲ in the occurrence group was higher than that in the non-occurrence group, and the left ventricular ejection fraction (LVEF) was lower than that in the non-occurrence group, with statistically significant differences (P < 0.05). The SF level in the occurrence group was lower than that in the non-occurrence group, and the NT-proBNP/eGFR was higher than that in the non-occurrence group, with statistically significant differences (P < 0.05). The SF level in patients with anemia was lower than that in patients without anemia, and the NT-proBNP/eGFR was higher than that in patients without anemia, with statistically significant differences (P < 0.05). Multivariate Logistic regression analysis showed that after adjusting for the NYHA cardiac function classification and LVEF, SF and NT-proBNP/eGFR were independent influencing factors for acute exacerbation of the disease in CHF patients with and without anemia (P < 0.05). The ROC curve showed that the AUC of the novel combined scheme (SF combined with NT-proBNP/eGFR) was significantly larger than those of SF, NT-proBNP/eGFR alone, and the conventional combined scheme (P < 0.05).

Conclusion Decreased SF level and increased NT-proBNP/eGFR are independent risk factors for acute exacerbation of CHF within 3 months, especially in patients with anemia. The combined application of the two indicators provides significant incremental predictive value compared with traditional clinical indicators.