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White blood cell count and mortality in patients with ischemic and nonischemic left ventricular systolic dysfunction
H A Cooper1, D V Exner, M A Waclawiw
1Clinical Trials Scientific Research Group, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA. Cooperh@nih.gov
Insights
Elevated white blood cell (WBC) counts in patients with left ventricular dysfunction predict higher mortality. A baseline WBC count over 7,000 cells/mm³ significantly increases the risk of death, particularly in ischemic cardiomyopathy.
Area of Science:
- Cardiology
- Clinical Research
- Biomarkers
Background:
- Left ventricular (LV) dysfunction is a significant risk factor for mortality.
- The role of inflammation, indicated by white blood cell (WBC) count, in predicting outcomes for LV dysfunction requires further clarification.
Purpose of the Study:
- To investigate the association between baseline white blood cell (WBC) count and all-cause mortality in patients with LV dysfunction.
- To determine if WBC count is an independent predictor of mortality in this population.
Main Methods:
- Retrospective analysis of the Studies Of Left Ventricular Dysfunction (SOLVD) trials.
- Statistical analysis to assess the relationship between baseline WBC count and mortality, adjusting for covariates.
Main Results:
- Higher baseline WBC counts (>7,000 cells/mm³) were associated with increased all-cause mortality (27% vs 21%, p <0.0001).
- Each 1,000/mm³ increase in WBC count was linked to a 5% increased risk of mortality (RR 1.05, p <0.001).
- A baseline WBC count >7,000 cells/mm³ significantly predicted increased mortality (RR 1.22, p = 0.001), especially in ischemic LV dysfunction (RR 1.26, p <0.001).
Conclusions:
- Baseline white blood cell (WBC) count is an independent predictor of mortality in patients with LV dysfunction.
- The association between elevated WBC count and mortality is particularly strong in patients with ischemic cardiomyopathy.
Abstract:
We conducted a retrospective analysis of the Studies Of Left Ventricular Dysfunction (SOLVD) trials to assess the predictive value of the baseline white blood cell (WBC) count on mortality. Mortality was higher in participants with a baseline WBC count >7,000 compared to those with a baseline WBC < or =7,000 (27% vs 21%, p <0.0001). After controlling for important covariates, each increase in WBC count of 1,000/mm3 was significantly associated with an increased risk of all-cause mortality (relative risk [RR] 1.05, p <0.001). Overall, compared with a baseline WBC count < or =7,000, a baseline WBC count >7,000 was significantly associated with an increased risk of all-cause mortality (RR 1.22, p = 0.001). In participants with ischemic left ventricular (LV) dysfunction, a WBC count >7,000 remained significantly associated with an increased risk of all-cause mortality (RR 1.26, p <0.001), whereas in participants with nonischemic LV dysfunction there was no relation between WBC count and mortality (RR 1.08, p = 0.5). Thus, baseline WBC is an independent predictor of mortality in patients with LV dysfunction, specifically in those with ischemic cardiomyopathy.
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