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

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

Journal of Cardiovascular Medicine: November 2017 - Volume 18 - Issue 11 - p 859–865
doi: 10.2459/JCM.0000000000000428
Research articles: Acute heart failure

Background Low relative lymphocyte count is an important prognostic marker in acute heart failure (AHF); however, it could be influenced by other abnormalities in white cells count. Our purpose is to evaluate if low absolute lymphocyte count (ALC) is an independent predictor of events in patients with AHF.

Methods In a retrospective analysis, we included 309 patients with AHF, divided into two groups according to the median value of ALC at admission (1410 cells/μl). The primary end point was all-cause mortality or urgent heart transplantation within 1 year.

Results Patients with low ALC were older and had more comorbidity, namely atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease and anemia. Low ALC was associated with higher all-cause mortality or urgent heart transplantation at 1 year (24.3 vs 13.0%; P = 0.012). In a multivariable model, the independent predictors of mortality at 1 year were ALC 1410 cells/μl or less at admission [hazard ratio 2.04; CI (confidence interval) 95% (1.06–3.95); P = 0.033], age [hazard ratio 1.08; CI 95% (1.04–1.12); P < 0.001], baseline serum creatinine [hazard ratio 1.25; CI 95% (1.05–1.50); P = 0.012] and baseline serum Na [hazard ratio 0.91; CI 95% (0.85–0.98); P = 0.013].

Conclusion 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.

Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy

Correspondence to Valentina Carubelli, Cardiology, Spedali Civili di Brescia, P.zza Spedali Civili 1, 25123 Brescia, Italy E-mail:

Received 11 February, 2016

Revised 20 July, 2016

Accepted 24 July, 2016

© 2017 Italian Federation of Cardiology. All rights reserved.