The Adjusted Ferritin Inflammation Index: A Novel Metric for Predicting Mortality in Heart Failure

Iron deficiency (ID) is common in heart failure (HF) patients and associated with poorer outcomes. However, traditional markers like ferritin and transferrin saturation (TSAT) may fail to accurately assess ID due to the confounding effects of inflammation. In this study, we introduce the Adjusted Ferritin Inflammation Index (AFII), a composite score combining ferritin/CRP ratio and albumin levels, designed to improve the precision of ID assessment in HF patients. A total of 322 HF patients with reduced ejection fraction were included in the analysis, following the application of specific inclusion and exclusion criteria. Multivariate analysis identified AFII as an independent predictor of mortality (HR: 2.155, 95% CI: 1.361–3.412, p = 0.001), demonstrating strong discriminatory power (AUC: 0.713). Survival analysis showed that patients with AFII ≥ 2.1 had significantly lower survival rates across all subgroups. These findings suggest that AFII could be a valuable tool for risk stratification in HF, offering a more comprehensive measure of mortality risk compared to traditional iron markers. Further validation in multi-center studies is needed to confirm its clinical utility.