Brief ReportThe relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure☆
Introduction
Acute heart failure (AHF) is a common but ill-defined clinical entity. Because of an aging population and improvement in survival rates after myocardial infarction, its prevalence is increasing [1], [2]. In addition, the syndrome is associated with a high short- and long-term mortality [3], [4], [5]. Recently, several effective but costly therapies have been developed [6], [7]. The difficulty remains to choose the most adequate treatment for each single patient with AHF. Hence, risk stratification is essential and urgently needed for appropriate triage and therapeutic decision making.
Lymphocytopenia is common in hospitalized patients [8]. A decrease of the relative lymphocyte count in percentages (%L) has been observed in different cardiovascular disease states. It has been interpreted as a marker of the physiological stress response, mediated by an increased release of endogenous catecholamines [9] or cortisol [10]. Importantly, a decrease in the %L has been demonstrated to be predictive for mortality in patients with chronic heart failure [11], [12], [13]. In patients with AHF though, the prognostic value of low %L is unknown. The aim of this study was to assess if the %L is a risk factor for long-term mortality in patients with AHF.
Section snippets
Study population
The present study is a subgroup analysis from a multicenter study, and the full results are published separately [5]. The study population included consecutive patients admitted to the medical intensive care unit, coronary care unit, and medical wards at the Department of Medicine of the University Hospital Zurich with a diagnosis of AHF. Diagnostic criteria for AHF were in accordance with the guidelines of the European Society of Cardiology [14] and included the following:
- 1.
an underlying heart
General
The study population included 96 consecutive patients with AHF. Mean age was 71 (SD 13), and 58 (60%) were men. A de novo AHF (no previous history of heart failure) was present in 28 (29%) patients. The most frequent underlying cardiac diseases were coronary artery disease in 57 (59%) patients and valvular cardiopathy in 24 (25%) patients. A history existed for atrial fibrillation in 21 (22%) patients and for elevated blood pressure in 51 (53%) patients. Left ventricular ejection fraction
Discussion
The present study revealed that a low %L on hospital admission was significantly related to an increased long-term mortality in patients with AHF. A decreased %L remained an independent risk factor after adjusting for age, sex, renal dysfunction, LVEF, shock, and coronary artery disease. The test had a good sensitivity to predict long-term mortality in patients with AHF. However, clinicians must consider its low specificity and poor positive predictive value.
Our results correspond to published
Acknowledgments
The authors thank Franco Salomon for his contribution to their understanding of the importance of the relative lymphocyte count.
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Dr Alain Rudiger was supported by grants from the Stiefel Zangger Foundation and the Swiss National Science Foundation.