title: Prognostic value of the absolute lymphocyte count in patients admitted for acute heart failure.
abstract: 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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.forename: Anna I
authors.initials: AI
authors.lastname: Castrini
authors.forename: Elio
authors.initials: E
authors.lastname: Gorga
authors.forename: Alice
authors.initials: A
authors.lastname: Ravera
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood
chemical_list: D012964:Sodium; D003404:Creatinine