Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction.
BACKGROUND
Elevation of total white blood cells (WBC) count is associated with higher mortality in patients with acute coronary syndromes. However, it is unknown which specific subset of leukocytes best correlates with increased risk of adverse outcome.


RESULTS
We prospectively studied the predictive value of WBC subtypes for long-term outcome in 1037 patients with acute myocardial infarction (AMI). Total WBC, neutrophil, monocyte and lymphocyte counts, and high-sensitivity C-reactive protein (CRP) were obtained in each patient. The median duration of follow up was 23 months (range, 6-42 months). Analyzed separately, baseline total WBC (HR 2.2, 95% CI 1.5-3.3; P<0.0001), neutrophil (HR 2.7, 95% CI 1.8-4.1; P<0.0001) and monocyte (HR 1.9, 95% CI 1.3-2.8; P=0.001) counts in the upper quartile, and lymphocyte count in the lower quartile (HR 1.5, 95% CI 1.1-2.3; P=0.03), were all independent predictors of mortality. Comparing nested models, adding other WBC data failed to improve model based on neutrophil count. In contrast, adding neutrophil count to the models based on total WBC (P=0.01), on monocyte count (P<0.0001) or on lymphocyte count (P<0.0001) improved the prediction of the models. Neutrophil count in the upper quartile (>or=9800 microL(-1)) remained a strong independent predictor of mortality after adjustment for left ventricular systolic function and for CRP (HR 2.2, 95% CI 1.6-3.0; P<0.0001).


CONCLUSIONS
Of all WBC subtypes, elevated neutrophil count best correlates with mortality in patients with AMI. Neutrophil count provides additive prognostic information when combined with CRP.
Dragu
Robert
R
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Huri
Shafik
S
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Zukermann
Robert
R
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Suleiman
Mahmoud
M
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Mutlak
Diab
D
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Agmon
Yoram
Y
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Kapeliovich
Michael
M
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Beyar
Rafael
R
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Markiewicz
Walter
W
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Hammerman
Haim
H
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Aronson
Doron
D
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa, Israel. Electronic address: d_aronson@rambam.health.gov.il.
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D007963:Leukocytes, Mononuclear / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D009504:Neutrophils / Q000502:physiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies
D002097:C-Reactive Protein