title: Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure.
abstract: BACKGROUND
  The aim of this study was to investigate the effect of a levosimendan infusion on hematological variables in patients with acute decompensated heart failure (ADHF). The predictive value of these variables for in-hospital mortality was also evaluated.
  
  
  METHODS
  A total of 553 patients (368 males; mean age, 63.4 ± 14.9 years) with acute exacerbations of advanced heart failure (ejection fraction ≤ 35%) and treated with either dobutamine or levosimendan were included in this retrospective analysis. The patients that received levosimendan therapy were divided into two groups according to in-hospital mortality: group 1 (21%) included patients who died during hospitalization (n=45), while group 2 (79%) included patients with a favorable outcome (n=174) after levosimendan infusion. Changes in several hematological variables between admission and the third day after levosimendan infusion were evaluated.
  
  
  RESULTS
  The demographic characteristics and risk factors of the two groups were similar. A comparison of changes in laboratory variables after the infusion of levosimendan revealed significant improvement only in those patients who had not died (group 2) during hospitalization. The neutrophil to lymphocyte (N/L) ratio after levosimendan infusion was an independent predictor of in-hospital mortality (odds ratio: 1.310, 95% CI: 1.158-1.483, p<0.001). In a receiver-operating characteristic curve analysis, a value of 5.542 for the N/L ratio after levosimendan administration was identified as an effective cut-off point for predicting in-hospital mortality (area under the curve=0.737; 95% confidence interval=1100-1301; p<0.001).
  
  
  CONCLUSIONS
  Levosimendan treatment was associated with significant changes in hematological variables in patients with ADHF. A sustained higher N/L ratio after levosimendan infusion is associated with an increased risk of in-hospital mortality in patients with ADHF.
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey. Electronic address: atasal01@gmail.com.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Tasal
authors.affiliation: Mehmet Akif Ersoy Thoracic-Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erturk
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Huseyın
authors.initials: H
authors.lastname: Uyarel
authors.affiliation: Mehmet Akif Ersoy Thoracic-Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Karakurt
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bacaksiz
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Vatankulu
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Turfan
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Sonmez
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Erdogan
authors.affiliation: Bezmialem Foundation University, Department of Cardiology, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
mesh_terms: D000208:Acute Disease; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D018450:Disease Progression; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D011724:Pyridazines / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine
keywords: Acute decompensated heart failure; Levosimendan; Neutrophil-to-lymphocyte ratio