Hypoalbuminemia and Lymphocytopenia in Patients With Decompensated Biventricular Failure

Battin, David L.; Ali, Sheharyar; Shahbaz, Atta U.; Ahmad, Mahmood; Davis, Richard C.; Newman, Kevin P.; Weber, Karl T.; Massie, James D.

doi:10.1097/maj.0b013e3181bfc83f

Cited by 46 publications

(27 citation statements)

References 35 publications

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“…Lymphopenia may be caused by lymphocyte apoptosis in atherosclerotic lesions, which gradually increases with atherosclerotic burden [23]. Moreover, several studies showed a relationship between low lymphocyte count and malnutrition [24, 25]. Thus, the combination of elevated neutrophils (nonspecific inflammation) and decreased levels of lymphocytes (regulatory component) into a single composite marker may provide additional information to interpret the pathogenesis of arterial stiffness [26].…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis

et al. 2016

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BackgroundPatients with peritoneal dialysis are in the persistent inflammation state and have elevated arterial stiffness. Neutrophil-lymphocyte ratio(NLR) is a new inflammatory marker in renal and cardiac disorders. Brachial-ankle pulse wave velocity (baPWV) is a non-invasive measurement, which is widely used as a surrogate marker of arterial stiffness. However, there is little evidence to show an association between NLR and baPWV in patients with peritoneal dialysis. The aim of this cross-section study was to investigate the relationship between NLR and arterial stiffness measured by baPWV in patients with peritoneal dialysis.MethodsIn this cross-section study, 101 patients with peritoneal dialysis were enrolled from January 2014 to June 2015. According to average baPWV level (1847.54 cm/s), the patients were categorized into two groups, low group and high group. baPWV, which reflects arterial stiffness, was calculated using the single-point method. Clinical data were collected in details. NLR was calculated using complete blood count. Associations between NLR and baPWV were assessed using Pearson’s correlation and linear regression analysis.ResultsThe NLR was significantly lower in the low baPWV group than in the high baPWV group (p = 0.03). There were positive correlations between baPWV and neutrophil count (r = 0.24, p = 0.01) and NRL(r = 0.43, P < 0.01), and there was a negative correlation between baPWV and lymphocyte count (r = -0.23, p = 0.01). In addition, albumin, phosphorous and intact parathyroid hormone showed negative correlations with baPWV (r = −0.32, p < 0.01; r = −0.28, p < 0.01; r = −0.25, p = 0.01, respectively). Age and hsCRP showed positive correlations with baPWV (r = 0.47, p < 0.01; r = 0.25, p = 0.01). In multivariate analysis, NLR independently correlated with baPWV in patients with peritoneal dialysis (β = 0.33, p < 0.01), even after adjustment for various confounders.ConclusionOur study suggests that NLR was an independently associated with arterial stiffness in patients with peritoneal dialysis. However, further prospective studies are needed to confirm cause-and-effect relationship between NLR and baPWV, and to investigate whether anti-inflammatory treatment could improve arterial stiffness in patients with peritoneal dialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0394-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis

et al. 2016

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“…23 In HHF specifically, elevated biventricular filling pressures and subsequent splanchnic congestion may cause direct enteric losses of lymphocytes. 24 Furthermore, this splanchnic congestive process may facilitate bacterial endotoxin translocation from the gut into the systemic circulation. 25,26 Robust immune activation and release of cytokines, such as tumor-necrosis factor-1, may directly relate to reductions in lymphocyte counts (particularly T-helper cell and B-cell subpopulations), 27 perhaps mediated by apoptotic mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Low Relative Lymphocyte Count in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Vaduganathan

Ambrosy

Greene

et al. 2012

Circ: Heart Failure

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Background-Low lymphocyte count has been shown to be an independent prognostic marker in heart failure (HF) in the outpatient setting. Limited data exist regarding whether relative lymphocyte count correlates with postdischarge outcomes in patients hospitalized for HF. Methods and Results-We performed a post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart FailureOutcome Study with Tolvaptan (EVEREST) trial, which randomized 4133 patients hospitalized for worsening HF with an ejection fraction ≤40% within 48 hours of admission to tolvaptan or placebo for a median follow-up of 9.9 months. The primary end points of all-cause mortality and cardiovascular mortality or HF hospitalization were analyzed in patients with available baseline complete blood counts (n=3717). Lymphocyte percentage was analyzed as a continuous variable. Times to events were compared using log-rank tests and multivariable Cox regression models. Patients with low lymphocyte percentage tended to be older and had higher rates of comorbid disease (diabetes mellitus, atrial fibrillation, and renal insufficiency). Low lymphocyte counts were associated with wide QRS duration, high natriuretic peptides, and low ejection fraction, blood pressure, and serum sodium. These patients were less likely to receive evidence-based HF medications. After adjusting for 22 known clinical risk factors, a 10% decrease in lymphocytes was associated with an increased hazard of all-cause mortality (adjusted hazard ratio 1.31 [95% CI: 1.14-1.150], P<0.001) and cardiovascular mortality or HF hospitalization (adjusted hazard ratio 1.14 [95% CI: 1.04-1.25], P=0.007) in the first 100 days postdischarge. Lymphopenia during hospitalization normalizes in majority of patients in the early postdischarge period. Conclusions-Low relative lymphocyte count during hospitalization for HF is an independent predictor of poor outcomes in the early postdischarge period, beyond traditional prognostic indicators. (Circ Heart Fail. 2012;5:750-758.)

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“…These mechanisms commonly lead to a protein-losing enteropathy, as was manifested in our patient [14]. The loss of immunoglobulins as well as lymphocyte-rich chyle creates a functionally immunocompromised host [14,15]. This immunocompromised state, as well as bacterial overgrowth and bacterial translocation were likely mediators of SBP in this patient and are the same risk factors previously described in the pathogenesis of SBP among cirrhotics [16][17][18].…”

Section: Discussionmentioning

confidence: 56%

Spontaneous bacterial peritonitis secondary to Streptococcus bovis in a patient with chronic chylous ascites

Tanna

Akerman²,

Ibrahim³

2011

European Journal of Gastroenterology & Hepatology

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Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis and ascites, and is predominantly caused by enteric organisms. Streptococcus bovis is a rare etiology of SBP that was first reported in 1994. Since then, few prior reports of SBP secondary to S. bovis have been observed in patients with underlying cirrhosis or hepatitis. We now present a case of SBP caused by S. bovis in the setting of chronic chylous ascites in a patient with no known liver pathology.

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Hypoalbuminemia and Lymphocytopenia in Patients With Decompensated Biventricular Failure

Cited by 46 publications

References 35 publications

Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis

Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis

Predictive Value of Low Relative Lymphocyte Count in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Spontaneous bacterial peritonitis secondary to Streptococcus bovis in a patient with chronic chylous ascites

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