Related Experiment Videos
Predictive power of the relative lymphocyte concentration in patients with advanced heart failure
S R Ommen1, D O Hodge, R J Rodeheffer
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn., USA.
Insights
A low percentage of lymphocytes (%L) is a significant predictor of survival in advanced heart failure patients. This simple marker can help assess prognosis and guide treatment decisions for heart failure management.
Area of Science:
- Cardiology
- Immunology
- Prognostics
Background:
- Physiological stress in heart failure increases cortisol and decreases lymphocyte percentage (%L).
- A decreased %L is observed in advanced heart failure patients.
Purpose of the Study:
- To determine the prognostic significance of a low %L in advanced heart failure.
- To assess if %L can predict survival and transplant-free survival.
Main Methods:
- Retrospective review of 211 advanced heart failure patients.
- Cox proportional hazards analysis to examine associations with survival.
- Exclusion of patients with recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or malignancy.
Main Results:
- Low %L (<20.3%) was significantly associated with mortality (P=.004).
- One- and 4-year survival rates were lower for patients with low %L (78% and 34%) compared to normal %L (90% and 73%).
- %L and NYHA class were independent predictors of survival and transplant-free survival.
Conclusions:
- Relative lymphocyte concentration is an inexpensive, simple prognostic marker for heart failure.
- It can aid in predicting patient outcomes and selecting candidates for cardiac transplantation.
- This marker is valuable in patients without recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or malignancy.
Background:
The physiological stress suffered by patients with heart failure results in an increased production of cortisol and a shift in the leukocyte differential toward a decreased percentage of lymphocytes (%L). The purpose of this study was to determine the prognostic significance of a low %L in advanced heart failure.
Methods And Results:
Patients evaluated in our cardiac transplantation clinic between April 1988 and July 1995 were retrospectively reviewed (n=263). Fifty-two patients were excluded because they had recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or history of malignancy. In the remaining 211 patients, we used Cox proportional hazards analysis to examine the association between survival and transplant-free survival with baseline variables. Univariate analysis showed a significant association between time to death and %L (P=.004), New York Heart Association (NYHA) class (P=.002), and maximal oxygen uptake (P=.05). Univariate analysis of the end point of survival free from transplantation yielded similar results. One- and 4-year survival rates for patients with a low %L (<20.3%) were 78% and 34% compared with 90% and 73% for those with a normal %L. Multivariate analysis showed NYHA class (P<.008) and %L (P<.01) were independent predictors of survival and survival free from cardiac transplantation.
Conclusions:
The relative lymphocyte concentration is an inexpensive, readily available, simple prognostic marker in patients with symptomatic heart failure who do not have recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or history of malignancy. It could be incorporated into clinical models to predict patient outcome and to aid in the selection of patients for cardiac transplantation.