Prognostic value of the absolute lymphocyte count in patients admitted for acute heart failure

Carubelli, Valentina; Bonadei, Ivano; Castrini, Anna Isotta; Gorga, Elio; Ravera, Alice; Lombardi, Carlo; Metra, Marco

doi:10.2459/jcm.0000000000000428

Cited by 13 publications

(8 citation statements)

References 35 publications

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“…The Pre-RELAX-AHF study showed that patients with AHF with a lower LYM ratio (<13%) during the 60-day and 180-day follow-up were associated with an increased risk of all-cause mortality (HR=1.11 [1.03-1.19]) (14). The same results were observed in another prospective cohort study involving 309 participants, where a low lymphocyte count (<1410/ml) was an independent predictor of long-term mortality in patients with AHF (HR=2.04 [1.06-3.95]) (15). Among patients with myocardial infarction, an increased NEU could be used to predict the development of AHF (38), while both a decreased and an increased PLT were associated with an increased mortality in a "U"-shaped relationship (16).…”

Section: Discussionsupporting

confidence: 83%

“…Among inflammatory markers, such as C-reactive protein (CRP), markers derived from complete blood count (including white blood cells [WBC], neutrophils [NEU], lymphocytes [LYM], monocytes [Mon], red blood cell distribution width [RDW] and platelets [PLT] have shown their important roles in inflammatory and immune responses, and changes in their level were associated with cardiovascular diseases (CVDs) as well as all-cause mortality (12)(13)(14)(15)(16)(17). More recently, inflammatory parameters derived from complete blood count (CBC), including neutrophil-to-lymphocyte ratio (NLR), platelet-tolymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), have been shown to be novel inflammatory biomarkers associated with cardiovascular diseases and their prognosis (18-22).…”

Section: Introductionmentioning

confidence: 99%

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Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

Zhu

Cheang

et al. 2022

Front. Immunol.

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Objective: Systemic inflammation is associated with a poor prognosis in acute heart failure (AHF). This study was to assess the long-term prognostic value of combining the accessible inflammatory markers in relation to all-cause mortality in patients with AHF.Methods: Consecutive patients with AHF who were hospitalized between March 2012 and April 2016 at the Department of Cardiology of the First Affiliated Hospital of Nanjing Medical University were enrolled in this prospective study. The LASSO regression model was used to select the most valuable inflammatory biomarkers to develop an inflammatory prognostic scoring (IPS) system. Kaplan-Meier method, multivariate COX regression and time-dependent ROC analysis were used to assess the relationship between inflammatory markers and AHF prognosis. A randomized survival forest model was used to estimate the relative importance of each inflammatory marker in the prognostic risks of AHF.Results: A total of 538 patients with AHF were included in the analysis (mean age, 61.1 ± 16.0 years; 357 [66.4%] men). During a median follow-up of 34 months, there were 227 all-cause deaths (42.2%). C-reactive protein (CRP), red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) were incorporated into the IPS system (IPS = 0.301×CRP + 0.263×RDW + 0.091×NLR). A higher IPS meant a significantly worse long-term prognosis in Kaplan-Meier analysis, with 0.301 points as the optimal cut-off value (P logrank <0.001). IPS remained an independent prognostic factor associated with an increased risk of all-cause mortality among patients with AHF in multivariate Cox regression models with a full adjustment of the other significant covariables. Random forest variable importance and minimal depth analysis Frontiers in Immunology frontiersin.org 01

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

Zhu

Cheang

et al. 2022

Front. Immunol.

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“…These data led us to speculate that immune cells are important to the postoperative organ injury in AAD patients. However, current risk assessment indices for AAD outcomes do not incorporate leukocyte subsets despite their close correlation with infection and heart failure ( 29 , 30 ). The present study is the first, to our knowledge, to directly assess the prognostic significance of lymphocyte counts alone in AAD patients after surgery.…”

Section: Discussionmentioning

confidence: 99%

Association of Apoptosis-Mediated CD4+ T Lymphopenia With Poor Outcome After Type A Aortic Dissection Surgery

Luo

Sun

Tang

et al. 2021

Front. Cardiovasc. Med.

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Background: Many patients with type A aortic dissection (AAD) show low lymphocyte counts pre-operatively. The present study investigated the prognostic values of lymphopenia and lymphocyte subsets for the postoperative major adverse events (MAEs) in AAD patients undergoing surgery, and explore mechanisms of lymphopenia.Methods: We retrospectively analyzed pre-operative lymphocyte counts in 295 AAD patients treated at two hospitals, and evaluated their correlation with MAEs. We prospectively recruited 40 AAD patients and 20 sex- and age-matched healthy donors (HDs), and evaluated lymphocyte subsets, apoptosis, and pyroptosis by flow cytometry.Results: Multivariable regression analysis of the retrospective cohort revealed pre-operative lymphopenia as a strong predictor of MAEs (odds ratio, 4.152; 95% CI, 2.434–7.081; p < 0.001). In the prospective cohort, lymphocyte depletion in the AAD group was mainly due to loss of CD4+ and CD8+ T cells as compared with HDs (CD4+ T cells: 346.7 ± 183.6 vs. 659.0 ± 214.6 cells/μl, p < 0.0001; CD8+ T cells: 219.5 ± 178.4 vs. 354.4 ± 121.8 cells/μl, p = 0.0036). The apoptosis rates of CD4+ and CD8+ T cells were significantly higher in AAD patients relative to HDs (both p < 0.0001). Furthermore, the pre-operative CD4+ T cells count at a cut-off value of 357.96 cells/μl was an effective and reliable predictor of MAEs (area under ROC curve = 0.817; 95% CI, 0.684-0.950; sensitivity, 74%; specificity, 81%; p < 0.005). Pre-operative lymphopenia, mainly due to CD4+ T cells exhaustion by apoptosis, correlates with poor prognosis in AAD patients undergoing surgery.Conclusion: Pre-operative lymphopenia in particular CD4+ T lymphopenia via apoptosis correlates with poor prognosis in AAD patients undergoing surgery.

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“…The prognostic value of the lymphocyte count has been evaluated in cardiovascular diseases 29 – 32 . A low lymphocyte count was related with an increased risk for myocardial infarction and death in patients with acute chest pain, a non-diagnostic electrocardiogram, and normal troponin levels.…”

Section: Discussionmentioning

confidence: 99%

Low serum lymphocyte level is associated with poor exercise capacity and quality of life in chronic obstructive pulmonary disease

Moon

Leem

Kim

et al. 2020

Sci Rep

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The purpose of this study was to evaluate the association of serum lymphocyte level with several clinical parameters in COPD. The study population included 451 COPD patients from the Korean Obstructive Lung Disease cohort study. Serum lymphocyte level was measured every year along with various clinical parameters, such as lung function, 6-min walking (6 MW) distance, quality of life using COPD assessment test (CAT) and St. George's Respiratory Questionnaire (SGRQ) scores, exacerbations, and survival. Serum lymphocyte level less than 20% was considered as a low lymphocyte level. Normal lymphocyte and low lymphocyte groups comprised of 409 (90.7%) and 42 (9.3%) patients, respectively. Clustered analysis showed that patients in low lymphocyte group had a lower post-bronchodilator forced expiratory volume in 1 s % predicted (estimated mean = − 5.70%; P = 0.001), a lower forced vital capacity % predicted (estimated mean = − 5.63%; P = 0.005), a shorter 6 MW distance (estimated mean = − 41.31 m; P < 0.001), a higher CAT score (estimated mean = 2.62; P = 0.013), and a higher SGRQ score (estimated mean = 10.10; P < 0.001). Serum lymphocyte level was not associated with frequent acute exacerbations nor mortality. Low serum lymphocyte group showed poorer pulmonary function, lower 6 MW distance, and worse quality of life. Serum lymphocyte levels could be a simple and widely available predictive marker for variable clinical outcomes in COPD patients.

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Prognostic value of the absolute lymphocyte count in patients admitted for acute heart failure

Abstract: Low ALC in patients with AHF is associated with higher in-hospital mortality during the hospitalization and is an independent predictor of long-term mortality.

Cited by 13 publications

References 35 publications

Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

Association of Apoptosis-Mediated CD4+ T Lymphopenia With Poor Outcome After Type A Aortic Dissection Surgery

Low serum lymphocyte level is associated with poor exercise capacity and quality of life in chronic obstructive pulmonary disease

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