title: Low lymphocyte ratio as a novel prognostic factor in acute heart failure: results from the Pre-RELAX-AHF study.
abstract: BACKGROUND
  Previous studies have suggested that a lower lymphocyte ratio (Ly%) in the white blood cell (WBC) differential count is related to worse outcomes in patients with acute heart failure (AHF) and other cardiovascular disorders.
  
  
  METHODS
  In the Pre-RELAX-AHF study, 234 patients with AHF, systolic blood pressure >125 mm Hg and brain natriuretic peptide ≥350 pg/ml or equivalent were randomized to 1 of 4 intravenous doses of relaxin or placebo and followed up for 6 months following randomization. Complete blood count and differential were performed by a central laboratory at baseline and then daily to day 5 and on day 14.
  
  
  RESULTS
  The WBC count by itself was not associated with measures of disease severity or outcome, and patients with Ly% <13% had similar baseline characteristics to patients with Ly% >13%, except for a higher baseline WBC count, elevated baseline glucose, older age and higher rates of peripheral vascular disease. However, patients with Ly% <13% had less improvement of dyspnea, greater worsening of heart failure, longer length of initial hospital stay and fewer days alive and out of hospital. Statistical significance was reached for all-cause death by days 60 and 180 (hazard ratio = 1.11 per percent decrease, 95% confidence interval 1.03-1.19; p = 0.0048).
  
  
  CONCLUSIONS
  Despite no association with any baseline characteristic known to strongly predict outcome in AHF, low Ly% is associated with less symptom relief and worse in-hospital and postdischarge clinical outcomes.
authors.affiliation: Momentum Research, Duke University, 3100 Tower Boulevard, Durham, NC 27707, USA. olgacotter@momentum-research.com
authors.forename: Olga
authors.initials: O
authors.lastname: Milo-Cotter
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Christopher
authors.initials: C
authors.lastname: Edwards
authors.forename: Beth Davison
authors.initials: BD
authors.lastname: Weatherley
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Elaine
authors.initials: E
authors.lastname: Unemori
authors.forename: Sam L
authors.initials: SL
authors.lastname: Teichman
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012065:Relaxin / Q000008:administration & dosage
chemical_list: D012065:Relaxin