The purpose of this study was to test the hypothesis that the Neutrophils to Lymphocytes count ratio (NLR) provides better correlate of the Heart failure (HF) the severity in addition to the physical examination in patients with suspected HF. Thus, its use in the resource limited health facilities lacking with ultrasound and or CT scan, may reduce treatment delay and also improve the follow-up and referral system for HF patients.

Patients admitted for HF underwent physical examination, ECG and echocardiogram. Venous blood collected from each patient was assessed for the haematological and biochemistry parameters.

Of 105 patients were included in this study, of them, 81 cases were classified into moderate including NYHA class I and II and 24 cases as severe including NYHA class III and IV. The median-age was 64.8 years (IQR: 55.5-72.6) and 58.4 (IQR: 52.3-67.84) for moderate and severe HF respectively. The NLR (p = 0.029) and HDL levels (p = 0.018) were found to be an independent risk factor for a severe HF. After adjusting other factors, area under the ROC curve of NLR and HDL in predicting severe HF were 0.68 (95% CI = 0.541–0.816) and 0.168 (95% CI = 0.076–0.259) respectively. NLR showed the better predicting ability of the severe HF.

Our findings revealed that NLR derived as a simple marker using a routine complete blood count data, was significantly and independently related to the severity of HF. Therefore, NLR is a potential indicator for HF severity in the resource limited health facilities.