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From the Division of Cardiovascular Diseases, Section of Medical Research
Statistics, Division of Cardiothoracic Surgery, Division of Endocrinology,
Mayo Clinic, Rochester, Minn.
Correspondence to Raymond J. Gibbons, MD, 200 First St SW, Rochester, MN 55905.
Background—The
physiological stress suffered by patients with
heart failure results in an increased production of cortisol
and a shift in the leukocyte differential toward a decreased percentage
of lymphocytes (%L). The purpose of this study was to determine the
prognostic significance of a low %L in advanced heart
failure.
Methods and Results—Patients evaluated in our cardiac
transplantation clinic between April 1988 and July 1995 were
retrospectively reviewed (n=263). Fifty-two patients were excluded
because they had recent trauma, infection, surgery, myocardial
infarction, corticosteroid use, or history of
malignancy. In the remaining 211 patients, we used Cox proportional
hazards analysis to examine the association between survival
and transplant-free survival with baseline variables.
Univariate analysis showed a significant
association between time to death and %L (P=.004), New
York Heart Association (NYHA) class (P=.002), and
maximal oxygen uptake (P=.05). Univariate
analysis of the end point of survival free from transplantation
yielded similar results. One- and 4-year survival rates for patients
with a low %L (<20.3%) were 78% and 34% compared with 90% and
73% for those with a normal %L. Multivariate
analysis showed NYHA class (P<.008) and %L
(P<.01) were independent predictors of survival and
survival free from cardiac transplantation.
Conclusions The relative lymphocyte concentration is an
inexpensive, readily available, simple prognostic marker in patients
with symptomatic heart failure who do not have recent
trauma, infection, surgery, myocardial infarction,
corticosteroid use, or history of malignancy. It could
be incorporated into clinical models to predict patient outcome and to
aid in the selection of patients for cardiac transplantation.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Predictive Power of the Relative Lymphocyte Concentration in Patients With Advanced Heart Failure
Key Words: heart failure • prognosis • transplantation
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