Heart failure
Effectiveness of the Relative Lymphocyte Count to Predict One-Year Mortality in Patients With Acute Heart Failure

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Several works have endorsed a significant role of the immune system and inflammation in the pathogenesis of heart failure. As indirect evidence, an association between a low relative lymphocyte count (RLC%) and worse outcomes found in this population has been suggested. Nevertheless, the role of RLC% for risk stratification in a large and nonselected population of patients with acute heart failure (AHF) has not yet been determined. Thus, the aim of this study was to determine the association between low RLC% and 1-year mortality in patients with AHF and consequently to define whether it has any role for early risk stratification. A total of 1,192 consecutive patients admitted for AHF were analyzed. Total white blood cell and differential counts were measured on admission. RLC% (calculated as absolute lymphocyte count/total white blood cell count) was categorized in quintiles and its association with all-cause mortality at 1 year assessed using Cox regression. At 1 year, 286 deaths (24%) were identified. A negative trend was observed between 1-year mortality rates and quintiles of RLC%: 31.5%, 27.2%, 23.1%, 23%, and 15.5% in quintiles 1 to 5, respectively (p for trend <0.001). After thorough covariate adjustment, only patients in the lowest quintile (<9.7%) showed an increased risk for mortality (hazard ratio 1.76, 95% confidence interval 1.17 to 2.65, p = 0.006). When RLC% was modeled with restricted cubic splines, a stepped increase in risk was observed patients in quintile 1: those with RLC% values <7.5% and <5% showed 1.95- and 2.66-fold increased risk for death compared to those in the top quintile. In conclusion, in patients with AHF, RLC% is a simple, widely available, and inexpensive biomarker, with potential for identifying patients at increased risk for 1-year mortality.

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,

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    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.

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