Heart failureEffectiveness of the Relative Lymphocyte Count to Predict One-Year Mortality in Patients With Acute Heart Failure
Section snippets
Methods
We prospectively studied a cohort of 1,268 patients, consecutively admitted to the cardiology department at Hospital Clínico Universitario de Valencia from January 1, 2004, to July 1, 2009, with diagnoses of AHF. AHF was defined as the rapid onset of symptoms and signs secondary to abnormal cardiac function and the presence of objective evidence of structural or functional abnormalities of the heart at rest (such as cardiomegaly, third heart sound, cardiac murmur, abnormality on
Results
The mean age in our sample was 73 ± 11 years; 50.8% were women, and 54% exhibited left ventricular ejection fractions >50%. The medians for total WBC, neutrophil count, lymphocyte count, and monocyte count were 9.4 × 103 cells/ml (interquartile range 7.5 to 12.10), 6.90 × 103 cells/ml (5.10 to 9.10 interquartile range), 1.40 × 103 cells/ml (1.01 to 20 interquartile range), and 0.46 × 103 cells/ml (0.35 to 0.60 interquartile range), respectively, and the median RLC% was 16% (interquartile range
Discussion
In the present study, using a nonselected hospitalized population of patients with AHF, we have shown that RLC% was inversely and, in a nonlinear fashion, associated with all-cause and CV mortality at 1 year. Importantly, our results can be viewed as a confirmation of previous and similar findings in a large and nonselected population with AHF.
In recent observational studies, RLC% has emerged as a prognostic marker in patients with HF.5, 6, 7, 8, 9 However, most of these studies were small6, 8,
References (30)
- et al.
The immune system and chronic heart failure: is the heart in control?
J Am Coll Cardiol
(2009) - et al.
Inflammatory biomarkers in heart failure revisited: much more than innocent bystanders
Heart Fail Clin
(2009) - et al.
Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure
Am Heart J
(2001) - et al.
Usefulness of relative lymphocyte count as an independent predictor of death/urgent transplant in heart failure
Am J Cardiol
(2005) - et al.
The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure
Am J Emerg Med
(2006) - et al.
Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood
Clin Immunol Immunopathol
(1980) - et al.
Elevated soluble cd14 receptors and altered cytokines in chronic heart failure
Am J Cardiol
(1997) - et al.
Endotoxin and immune activation in chronic heart failure: A prospective cohort study
Lancet
(1999) Immune activation in chronic heart failure
Am J Cardiol
(2005)- et al.
Systemic inflammation in heart failure—the whys and wherefores
Heart Fail Rev
(2006)
The seattle heart failure model: Prediction of survival in heart failure
Circulation
Predictive power of the relative lymphocyte concentration in patients with advanced heart failure
Circulation
Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of CardiologyDeveloped in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur Heart J
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology
Eur Heart J
Executive summary: heart disease and stroke statistics—2010 update: A report from the American Heart Association
Circulation
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Lymphocytopenia During Hospitalization for Acute Heart Failure and Its Relationship With Portal Congestion and Right Ventricular Function
2020, Journal of Cardiac FailureCitation Excerpt :These relationships between low lymphocytes and poor outcomes have also been demonstrated by others, in a variety of clinical settings and using various thresholds defining lymphocytopenia.3,26,39,40 As such, in AHF, the associations between low lymphocytes and poor outcomes have previously been demonstrated, such that lymphocytopenia was associated with poor outcomes after discharge.2,41,42 Low lymphocytes also seemed to be associated with higher risks of all-cause death in patients with chronic HF outside the setting of a recent hospitalization for decompensated HF39,43 and death or urgent transplantation.22,26
Relation of Low Lymphocyte Count to Frailty and its Usefulness as a Prognostic Biomarker in Patients >65 Years of Age With Acute Coronary Syndrome
2020, American Journal of CardiologyCitation Excerpt :Whether low Lymph% is directly involved in the pathogenesis of frailty or whether it is just a marker of frailty or prefrailty status is an issue this study was not intended to address, and thus, it will require further investigations. However, the fact that lymphopenia may predispose patients to infections, which in turn are a well-known cause of death and a functional decline, may be considered as indirect evidence of a biological linking.13,14,22 The present study has some limitations that need to be mentioned.
Joint effects of uric acid and lymphocyte count on adverse outcomes in elderly patients with rheumatic heart disease undergoing valve replacement surgery
2019, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Decreased lymphocyte count was another phenomenon in patients with heart failure because of increased neurohormonal activation. Increased cortisol and catecholamines were postulated to be the underlying mechanism causing lymphopenia by triggering apoptosis and downregulating the proliferation and differentiation of lymphocytes.26,27 In addition, RHD is an autoimmune disease and inflammatory response still persists in its chronic phase.28
The lymphocyte-to-monocyte ratio: An added value for death prediction in heart failure
2015, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Individual leukocyte subpopulations represent single elements of the leukocyte differential and immunological processes. In patients with HF, lower relative lymphocyte counts have been associated with worse outcomes [19–22]. It is also evident from our study that lower relative lymphocyte counts were associated with all-cause death and a trend to predict HF death.
Procalcitonin and long-term prognosis after an admission for acute heart failure
2015, European Journal of Internal MedicineCitation Excerpt :AHF is a systemic disorder characterized by persistent immune activation and inflammation [16]. Several works have shown the existence of a steady stream of circulating pro-inflammatory biomarkers, commonly related to poor outcomes and progression of the disease [17-20]. In decompensate stages and in absence of bacterial infections, it has been proposed that endotoxin translocation from the gut may be an important stimulus for cytokine production in patients with AHF, its effect mediated through its action on mononuclear cells, and with bowel edema and hypoperfusion as triggering factors [21].
Prognostic value of monocyte count in patients hospitalized for heart failure with reduced ejection fraction (from the EVEREST Trial)
2012, American Journal of CardiologyCitation Excerpt :In addition, it is interesting to compare our results to existing data regarding other WBC subsets in HF, notably lymphocytes. In contrast to our findings with increased monocyte count, a significant proportion of patients with HF are found to have a decreased lymphocyte count during their clinical course and low lymphocyte counts (expressed as a percentage and as a ratio to total WBC count) have consistently been shown to predict worse outcomes.8–10 Proposed mechanisms for decreased lymphocytes in HF relate to cytokine-mediated lymphocyte apoptosis and to increased levels of endogenous cortisol and catecholamines.11–13
This study was supported by a grant from Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, RED HERACLES RD06/0009/1001, Madrid, Spain, Beca Fundación Española del Corazón Basic Research and PI080128.