title: The ratio of the neutrophil leucocytes to the lymphocytes predicts the outcome after cardiac resynchronization therapy.
abstract: OBJECTIVE
  The low lymphocyte counts and high neutrophil leucocyte fractions have been associated with poor prognosis in chronic heart failure. We hypothesized that the baseline ratio of the neutrophil leucocytes to the lymphocytes (NL ratio) would predict the outcome of chronic heart failure patients undergoing cardiac resynchronization therapy (CRT).
  
  
  RESULTS
  The qualitative blood counts and the serum levels of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) of 122 chronic heart failure patients and 122 healthy controls were analysed prospectively in this observational study. The 2-year mortality was considered as primary endpoint and the 6-month reverse remodelling (≥15% decrease in the end-systolic volume) as secondary endpoint. Multivariable regression analyses were applied and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. The NL ratio was elevated in chronic heart failure patients when compared with the healthy controls [2.93 (2.12-4.05) vs. 2.21 (1.64-2.81), P < 0.0001]. The baseline NL ratio exceeding 2.95 predicted the lack of the 6-month reverse remodelling [n = 63, odds ratio = 0.38 (0.17-0.85), P = 0.01; NRI = 0.49 (0.14-0.83), P = 0.005; IDI = 0.04 (0.00-0.07), P = 0.02] and the 2-year mortality [n = 29, hazard ratio = 2.44 (1.04-5.71), P = 0.03; NRI = 0.63 (0.24-1.01), P = 0.001; IDI = 0.04 (0.00-0.08), P = 0.02] independently of the NT-proBNP levels or other factors.
  
  
  CONCLUSIONS
  The NL ratio is elevated in chronic heart failure and predicts outcome after CRT. According to the reclassification analysis, 4% of the patients would have been better categorized in the prediction models by combining the NT-proBNP with the NL ratio. Thus, a single blood count measurement could facilitate the optimal patient selection for the CRT.
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: András Mihály
authors.initials: AM
authors.lastname: Boros
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Széplaki
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Perge
authors.affiliation: Third Department of Internal Medicine, Semmelweis University, Hungary.
authors.forename: Zsigmond
authors.initials: Z
authors.lastname: Jenei
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bagyura
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Endre
authors.initials: E
authors.lastname: Zima
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Levente
authors.initials: L
authors.lastname: Molnár
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Astrid
authors.initials: A
authors.lastname: Apor
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: Dávid
authors.initials: D
authors.lastname: Becker
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gellér
authors.affiliation: Third Department of Internal Medicine, Semmelweis University, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Prohászka
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor utca 68, Budapest H-1122, Hungary merkely.bela@gmail.com merkely.bela@kardio.sote.hu.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D006814:Hungary; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009504:Neutrophils / Q000166:cytology*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Chronic heart failure; Lymphocyte; Neutrophil; Outcome; Reclassification; Resynchronization