Prognostic Impact of the Naples Prognostic Score in Patients With Type 2 Cardiorenal Syndrome: A Retrospective Cohort Study

Objective: Type 2 cardiorenal syndrome (CRS-2) is characterized by progressive renal dysfunction secondary to chronic heart failure and is associated with high mortality. The Naples Prognostic Score (NPS), integrating inflammatory and nutritional parameters, has emerged as a prognostic marker in cardiovascular diseases. This study aimed to investigate the prognostic value of the Naples Prognostic Score for predicting in-hospital mortality in patients with CRS-2. Methods: This retrospective cohort study included 101 adult patients hospitalized with CRS-2 in the cardiology department of a tertiary referral center between June 2021 and August 2024. NPS was calculated using admission laboratory parameters, and patients were stratified into low NPS (Stage 1–2) and high NPS (Stage 3) groups. Clinical variables including age, comorbidities, and New York Heart Association (NYHA) functional class were recorded. Univariable and multivariable logistic regression analyses were performed to identify predictors of in-hospital mortality. Discriminative performance of NPS was evaluated using receiver operating characteristic (ROC) analysis. Results: In-hospital mortality was significantly higher in the high NPS group compared with the low NPS group (54.5% vs. 11.8%, p < 0.001). In multivariable analysis, high NPS remained independently associated with in-hospital mortality (OR: 4.79, 95% CI: 1.34–17.15, p = 0.016), together with older age (OR: 1.09, 95% CI: 1.02–1.17, p = 0.007) and higher NYHA class (OR: 5.21, 95% CI: 1.97–13.81, p = 0.001). ROC analysis showed good predictive ability of NPS (AUC: 0.816; optimal cut-off ≥ 2; sensitivity 92.3%, specificity 62.7%). Conclusion: The Naples Prognostic Score may provide a simple and practical tool for early risk stratification of patients with type 2 cardiorenal syndrome at hospital admission.