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The lymphocyte-to-monocyte ratio: an added value for death prediction in heart failure
N Silva1, P Bettencourt2, J T Guimarães3
1Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Serviço de Patologia Clínica, Centro Hospitalar São João, 4202-451 Porto, Portugal.
Insights
A lower lymphocyte-to-monocyte ratio (LMR) in acute heart failure (HF) patients predicts a higher risk of death within six months. This finding highlights LMR as a potential prognostic marker for HF outcomes.
Area of Science:
- Cardiology
- Hematology
- Clinical Research
Background:
- Leukocytes and their subpopulations are implicated in heart failure (HF) progression.
- Previous studies suggest leukocytes predict worse outcomes and influence myocardial remodeling.
- The prognostic value of the lymphocyte-to-monocyte ratio (LMR) in HF remained unevaluated.
Purpose of the Study:
- To evaluate the lymphocyte-to-monocyte ratio (LMR) as a prognostic marker in patients with acute heart failure (HF).
- To determine the association between LMR and mortality endpoints in HF patients.
Main Methods:
- A cohort of 390 acute HF patients was followed for 6 months.
- Leukocyte differential counts were analyzed, and patients were grouped by HF death and LMR cut-off.
- Multivariate Cox-regression models assessed prognostic value for HF and all-cause mortality.
Main Results:
- Patients who died of HF had significantly lower LMR values.
- Lower LMR (<2.0) was independently associated with increased 6-month risk for both HF mortality (HR 2.28) and all-cause mortality (HR 2.39).
- Leukocyte and monocyte counts were associated with risk, while lymphocyte counts predicted all-cause mortality.
Conclusions:
- A lower lymphocyte-to-monocyte ratio (LMR) upon hospital discharge is independently linked to increased 6-month mortality risk in acute heart failure (HF) patients.
- LMR serves as a valuable prognostic indicator in the context of acute HF.
Background And Aim:
Leukocytes and their subpopulation have been long implicated in the progression of the syndrome of heart failure (HF), especially heart infiltration cells. Previous reports have suggested that they can predict worse outcome in patients with HF, and can also affect the function of other cells and myocardial extracellular matrix remodeling process. However, the lymphocyte-to-monocyte ratio (LMR) and its possible value as prognostic marker have not been evaluated.
Methods And Results:
A total of 390 patients with acute HF were recruited and followed for 6 months. Their total blood count with leukocyte differential was obtained. Two groups were formed according to the endpoints of HF death and optimal cut-off value of LMR, and were compared. A multivariate Cox-regression model was used to establish the prognostic value with the endpoints of HF and all-cause mortality. Median age of the patients was 78 years and 48.5% of them were men. No major difference was observed between the clinical characteristics of the two groups. Patients who died of HF had significantly higher values of B-type natriuretic peptide and lower values of LMR. Leukocyte and monocyte counts revealed a multivariate-adjusted risk for both endpoints, whereas relative lymphocyte counts had only significant value for all-cause mortality. The multivariate-adjusted hazard ratios for the 6-month HF and all-cause mortality in patients with LMR values < 2.0 were, respectively, 2.28 (95% CI: 1.25-4.15) and 2.39 (95% CI: 1.39-4.10).
Conclusion:
Our results show that, upon discharge from hospital after an episode of acute HF, a lower value of LMR is independently associated with a higher risk of mortality within 6 months.
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