Abstract Body (Do not enter title and authors here): Background: Heart failure (HF) is associated with systemic inflammation and hypercatabolic syndrome, impacting body metabolism. The advanced lung cancer inflammation index (ALI) is a novel inflammatory and nutritional biomarker.

Purpose: We aimed to investigate the prognostic role of ALI in patients with HF.

Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. This meta-analysis was registered at PROSPERO (CRD42024535227).

Results: We included four studies with 2,247 patients. In the pair-wise meta-analysis, ALI ≤ 25 was significantly associated with an increased incidence of all-cause mortality compared with ALI > 25 (risk ratio [RR] 1.73, 95% confidence interval [CI] 1.36-2.21, P< 0.01). On the adjusted prognostic meta-analysis, higher ALI (>25) was significantly associated with a reduction in the incidence of all-cause mortality (hazards ratio [HR] 0.45, 95% CI 0.35-0.58, P< 0.01). The reconstructed Kaplan Meier showed that ALI > 25 was significantly associated with a 56% reduction in the incidence of all-cause mortality compared with ALI ≤ 25 (HR 0.44, 95% CI 0.38-0.50, P< 0.000001).

Conclusion: Among patients with HF, a low ALI was associated with a higher incidence of all-cause mortality rate than those with a high ALI. These findings suggest that ALI can be used for prognostic stratification and aid clinical decision-making in HF management.