Objetives: The leuko-glycemic index, indicating inflammatory and metabolic responses, holds prognostic value in acute coronary syndromes. Yet, its significance in severe aortic stenosis patients and its link to obesity remain unexplored. This study aims to assess the clinical implications of the leuko-glycemic index in severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI), examining its association with obesity.

Methods and results: This study was a single-centre, observational, retrospective clinical investigation that enrolled patients admitted to the hospital with symptomatic severe aortic stenosis undergoing TAVI between 2020 and 2023. Patients were categorized based on the presence or absence of obesity (defined as a body mass index >30 kg/m²), and the leuko-glycemic index was calculated using the formula: [blood glucose (mg/dL) * leukocytes (/mm³) / 1000] as previously described.The predictive capacity of the leuko-glycemic index for adverse clinical events was assessed using a receiver operating characteristic curve and the area under the curve (AUC). Adverse clinical outcomes were assessed based on the Valve Academic Research Consortium-3 (VARC-3) criteria, evaluating the incidence of acute kidney injury and cardiovascular re-hospitalizations. Additionally, a Cochran-Mantel-Haenszel test was conducted to evaluate the conditional dependence between the leuko-glycemic index, acute kidney injury, and rehospitalizations concerning the presence or absence of obesity.The mean age of the population (n: 312) was 82.09 ± 6.78 years, comprising 48.0% males and 61.6% classified as obese. In obese patients, the median leuko-glycemic index was 707.35 (IQR 564.17-887.37), whereas in non-obese patients, it was 684.42 (IQR 518.87-848.97). The AUC for the leuko-glycemic index was 0.588 ([CI95% 0.525-0.652]; p=0.007), with a cut-off value of 684.126, demonstrating a sensitivity of 63%, specificity of 52.5%, a positive predictive value of 29.0%, and a negative predictive value of 82.1%. Significantly higher incidences of acute kidney injury and cardiovascular re-hospitalizations were observed in patients with a leuko-glycemic index value >684.126 compared to those with a lower index value (63% vs. 47.5%; p=0.007).Conditional dependence concerning acute kidney injury, cardiovascular re-hospitalizations, and the leuko-glycemic index was observed in relation to the presence or absence of obesity (p=0.005 in obese patients vs. p=0.261 in non-obese patients; Cochran-Mantel-Haenszel test, p=0.073).

Conclusions: In patients undergoing TAVI for severe aortic stenosis, the leuko-glycemic index emerged as a predictive parameter for adverse clinical events. A higher leuko-glycemic index value correlated with increased occurrences of acute kidney injury and re-hospitalizations. Notably, this association was observed solely in patients without obesity.