Hospitalization Events In Patients Research Articles

Impact of malnutrition on clinical outcomes in patients diagnosed with COVID-19.

BackgroundCoronavirus disease 2019 (COVID‐19) is now the third leading cause of death in the United States. Malnutrition in hospitalized patients increases risk of complications. However, the effect of malnutrition on outcomes in patients infected is unclear. This study aims to identify the impact of malnutrition on mortality and adverse hospital events in patients hospitalized with COVID‐19.MethodsThis study used data from the National COVID Cohort Collaborative (N3C), a COVID‐19 repository containing harmonized, longitudinal electronic health record data from US health systems. Malnutrition was categorized into three groups based on condition diagnosis: (1) none documented, (2) history of malnutrition, and (3) hospital‐acquired malnutrition. Multivariable logistic regression was performed to determine whether malnutrition was associated with mortality and adverse events, including mechanical ventilation, acute respiratory distress syndrome, extracorporeal membrane oxygenation, and hospital‐acquired pressure injury, in hospitalized patients with COVID‐19.ResultsOf 343,188 patients hospitalized with COVID‐19, 11,206 had a history of malnutrition and 15,711 had hospital‐acquired malnutrition. After adjustment for potential confounders, odds of mortality were significantly higher in patients with a history of malnutrition (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.63–1.79; P < 0.001) and hospital‐acquired malnutrition (OR, 2.5; 95% CI, 2.4–2.6; P < 0.001). Adjusted odds of adverse hospital events were also significantly elevated in both malnutrition groups.ConclusionsResults indicate the risk of mortality and adverse inpatient events in adults with COVID‐19 is significantly higher in patients with malnutrition. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.

Analysis of Hospitalization Events in Patients with Primary Hemophagocytic Lymphohistiocytosis (HLH) Treated with Emapalumab

Background Primary HLH is a rare, genetic immune-mediated disorder, usually diagnosed during infancy or early childhood. It is characterized by severe and often life-threatening immune activation, hyperinflammation and immune-mediated organ damage. Like some other rare diseases, the epidemiology of primary HLH is not well defined. Published data suggest the annual incidence of primary HLH is 1.8 per 100,000 live births in Sweden (Meeths et al. Pediatr Blood Cancer 2015). Current conventional treatment for primary HLH includes chemoimmunotherapy to suppress the immune hyperactivation and then offering patients the only potentially curative treatment, namely allogenic hematopoietic stem cell transplantation (HSCT). Chemoimmunotherapy (as recommended in the HLH-94 and HLH-2004 treatment protocols) is based on the combined use of dexamethasone, etoposide and cyclosporine. The side effects associated with these drugs are expected to increase the burden of the illness. Emapalumab, a fully human monoclonal antibody that neutralizes IFN-gamma, is approved in the USA for use in adult and pediatric patients with primary HLH with refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. Patients with primary HLH are likely to be hospitalized for extended periods during diagnosis and chemoimmunotherapy (8-week induction course followed by continuation phase until HSCT). Most published data for primary HLH focus on the treatment and management of HLH in treatment-naïve patients; data from the largest prospective study on HLH reported that the median time to HSCT was 148 days (range, 25-2105) (Bergsten et al. Blood 2017). We performed a post-hoc analysis of the NI-0501-04/05 study, which followed patients treated with emapalumab for up to 1-year post-HSCT, to assess the patterns of hospitalization. Methods Emapalumab was evaluated in an open-label, single-arm, multicenter phase 2/3 trial in patients aged ≤18 years with suspected or confirmed primary HLH (NCT01818492; Locatelli et al. N Engl J Med 2020). Patients were treatment-naïve or -experienced, with active disease at enrollment; treatment-experienced patients had shown worsened/reactivated disease, poor response to conventional therapy, or were unable to continue treatment due to adverse events. Emapalumab was administered as an intravenous infusion at an initial dose of 1 mg/kg every 3 days and subsequent doses could be increased to 3, 6 and 10 mg/kg if required. Treatment duration was 8 weeks, with possible shortening to a minimum of 4 weeks, or extension up to the time of HSCT if needed. Patients were required to stay in hospital initially for 2 weeks, and then could return home whilst awaiting HSCT at the discretion of the treating physician. Patients were invited to participate in a long-term follow-up study for up to 1 year after the last dose of emapalumab or after HSCT. They could continue treatment with emapalumab beyond week 8 if HSCT was delayed and the benefit-risk ratio was considered favorable (NCT02069899). Post-hoc analyses were conducted using data from all patients who received of ≥1 dose of emapalumab. Descriptive analyses were performed for the hospitalization data collected. Results The study population comprised treatment-naïve (n=7) and treatment-experienced patients (n=27). All patients were hospitalized for at least 2 weeks as per the trial protocol. The mean (standard deviation [SD]) duration of hospitalization until HSCT, death or end of study (EOS) was 83 (47) and 64 (35) days in treatment-naïve and treatment-experienced patients, respectively (Table 1). Twenty (59%) patients were discharged while waiting for HSCT. The mean (SD) period of time spent at home until HSCT, death or EOS was 164 (212) and 61 (106) days in treatment-naïve and treatment-experienced patients, respectively. Conclusions Over 50% of treatment-naïve and -experienced patients with HLH who received emapalumab were permitted to be at home for an average of 12 weeks. Reduced length of hospitalization is expected to lead to improved patient health-related quality of life, reduced burden on patients and caregivers, and reduced healthcare utilization and costs. These factors are intended to be explored within future research studies. Disclosures Wilson: Sobi: Current Employment, Current equity holder in publicly-traded company. Pochopien:Sobi: Consultancy. Nazir:Sobi: Current Employment. Rao:Sobi: Consultancy, Other: Advisory Board. Locatelli:Miltenyi: Speakers Bureau; Bellicum Pharmaceutical: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz Pharmaceeutical: Speakers Bureau; Medac: Speakers Bureau.

Low Serum 3-Methylhistidine Levels Are Associated With First Hospitalization in Kidney Transplantation Recipients

BackgroundLow protein intake and increased muscle breakdown are associated with increased mortality risk in patients with kidney transplantation (KT). 3-methylhistidine (3-MH), a nonproteinogenic amino acid residue, is an index of muscle breakdown. the present study investigated the association between serum 3-MH levels and subsequent first hospitalization events in patients with KT. MethodsA total of 64 KT patients were enrolled and 43 first hospitalization events occurred. Fasting blood samples were obtained and serum 3-MH level was performed with high-performance liquid chromatography and mass spectrometry. Associations between serum 3-MH levels and first hospitalization over a 5-year follow-up period were examined. ResultsCompared with patients without hospitalization, the 64 patients with KT revealed higher diabetes (P = .012) and hypertension (P = .006) prevalence, higher body fat mass (P = .012) and systolic blood pressure (P = .002), higher serum blood urea nitrogen (BUN) levels (P = .003), and lower serum 3-MH levels (P = .001). Statistical analysis revealed that serum 3-MH (95% confidence interval [CI]: 0.902-0.986, P = .010) and serum BUN (95% CI: 1.003-1.040, P = .022) levels were independently associated with first hospitalization events in patients with KT. Kaplan-Meier analysis showed a greater cumulative incidence of first hospitalization events in the patients with lower 3-MH levels (≤5.91 ng/mL) than that in those with higher 3-MH levels (P = .014; log-rank test). ConclusionsLow serum 3-MH levels are associated with increased first hospitalization risk in KT recipients.

Retinol-binding protein is an independent risk factor for hospitalization events in patients undergoing hemodialysis

Objective To explore the risk factors related to hospitalization events in out patients on hemodialysis and to evaluate the effect of serum retinol-binding protein (RBP) level on hospitalization events in patients on hemodialysis. Methods Case-control study. A total of 80 patients on dialysis were recruited, including 47 men (58.8%) and 33 women (41.2%), with an average age of (60.9±11.7) years (range: 32-89 years) and a median dialysis age of 43.6 months. Dialysis-related data were collected, the serum RBP level was detected using the ELISA method. Patients were followed-up until June 30, 2019, to record the events associated with all kinds of hospitalization events. The t-test, Mann-Whitney U test and chi-square test were used to compare the differences between the hospitalized event group and the non-event group. Multivariate logistic regression was used to analyze the related risk factors of hospitalization events. The Kaplan-Meier method, Log-rank test, and Cox proportional hazards regression model were used to analyze survival data. Results During the 19-month follow-up period, 26/80 patients (32.5%) had 67 events of hospitalization. There was no difference (P>0.05) in age, sex composition, dialysis age, ratio of diabetes/hypertension, interval dialysis weight gain (IDWG), systolic/diastolic blood pressure before dialysis, kt/v and URR between the groups with or without hospitalization events. The cut-off point of serum RBP was calculated using the patient′s highest Youden index. The patients were divided into the high-RBP group (n=44) and low-RBP group (n=36) according to the level of 165.34 mg/L. The incidence of hospitalization events in the high-RBP group was higher than that in the low-RBP group (45.45%>16.67%, P=0.006). Using the multivariate logistic regression model, after adjusting for sex, age, albumin and total cholesterol (CHO), only the serum RBP level was independently correlated with hospitalization events. The high-RBP group had an odds ratio (OR) of 3.64 (95%CI, 1.14-11.58; P=0.029) compared with the low-level group in hospitalization events. The Kaplan-Meier survival analysis showed that the incidence of hospitalization events in the high-RBP group was significantly higher than that in the low-RBP group (P=0.0058). The test results of the multivariable Cox proportional hazards regression model showed that for patients on hemodialysis, an elevated serum RBP level is an independent risk factor for hospitalization events. Conclusion Elevated serum RBP level is correlated with hospitalization events in patients on hemodialysis. RBP is an independent risk factor for hospitalization events in outpatients on hemodialysis. Key words: Retinol-binding proteins; Renal dialysis; Risk factors

Trimethylamine-N-oxide is an independent risk factor for hospitalization events in patients receiving maintenance hemodialysis

Background Hospitalization is a significant outcome measurement for maintenance hemodialysis pantients. Trimethylamine-N-oxide (TMAO), created by gut microflora from dietary l-carnitine and choline, cleared by the kidney, has been implicated in the causation of cardiovascular diseases in patients with chronic kidney disease. However, whether it associates with hospitalization risk for these patients is unclear. Methods In this study, 69 patients undergoing outpatient dialysis were enrolled. Enzyme-linked immunosorbent assay was used to quantitate the baseline plasma TMAO levels in patients. The patients were divided into a high TMAO level group (TMAO ≥ 15 μmol/L) and a low TMAO level group (TMAO < 15 μmol/L). During the 1-year follow-up, 1-year dialysis-related data and all-cause hospitalization events were recorded. Results The incidence of hospitalization events was significantly higher in the high TMAO level group than in the low TMAO level group (91 per 100 patient-year vs. 32 per 100 patient-year). The Kaplain–Meier survaial analysis showed that the incidence of hospitalization events in the high TMAO level group was significantly higher than that in the low TMAO level group (log-rank p = 0.0004). After adjustment age, sex, CK-MB and albumin, the results of multivariate Cox proportional hazard analysis showed that high TMAO level was an independent risk factor for hospitalization in maintenance hemodialysis patients. Conclusion TMAO is an independent risk factor for hospitalization events in patients receiving maintenance hemodialysis. It may be a new therapeutic target for improving the outcomes of these patients.

Associations Between High Serum Adipocyte Fatty Acid Binding Protein and First Hospitalization in Kidney Transplantation Patients

Introduction Adipocyte fatty acid-binding protein (A-FABP) is an adipokine and predicts the incidence of metabolic syndrome and type 2 diabetes mellitus and is an independent association with atherosclerosis. This study was evaluated the association between serum A-FABP levels and future first hospitalization events in patients with kidney transplantation (KT). Materials and Methods A total of 72 KT patients were enrolled in this study from January through April 2012. The primary end point was the incidence of first hospitalization. All patients are follow-up until June 2017.Fasting blood samples were obtained from 74 KT patients. Serum A-FABP levels were determined using a commercially available enzyme immunoassay. Results During a median 65-month follow-up, Forty-nine first hospitalization events occurred. Compared with serum median A-FABP levels, female KD patient had higher A-FABP levels(P = 0.033) and serum A-FABP level was positively associated with body mass index (P = 0.036), body fat mass (P = 0.004), systolic blood pressure (P = 0.003), total cholesterol (P = 0.014), triglyceride (P = 0.010), blood urea nitrogen (P = 0.001), creatinine (P = 0.032), while negatively associated with height (P = 0.029), glomerular filtration rate (P = 0.008), respectively. KT patients with first hospitalization events and higher prevalence of diabetes (P = 0.027), hypertension (P = 0.049), higher body fat mass (P = 0.024), and higher serum A-FABP levels (P = 0.011) compared to subjects without first hospitalization events. The Kaplan–Meier analysis showed that the cumulative incidence of the first hospitalization events in the high A-FABP group (median A-FABP concentration of ≥ 29.05 ng/mL) was greater than that in the low A-FABP group (log-rank P = 0.018). By multivariate Cox analysis showed that hypertension (hazard ratio (HR): 2.134, 95% confidence interval (CI): 1.190–3.828, P = 0.011) and serum A-FABP levels (HR: 1.010, 95% CI: 1.000–1.019, P = 0.047) was independently associated with first hospitalization events in KT patients. Conclusion The results of our study showed that the serum A-FABP level is a biomarker for future first hospitalization events in KT patients. Further prospective studies are needed to confirm the mechanisms underlying this association.

Multisite prediction of 4-week and 52-week treatment outcomes in patients with first-episode psychosis: a machine learning approach

At present, no tools exist to estimate objectively the risk of poor treatment outcomes in patients with first-episode psychosis. Such tools could improve treatment by informing clinical decision-making before the commencement of treatment. We tested whether such a tool could be successfully built and validated using routinely available, patient-reportable information. By applying machine learning to data from 334 patients in the European First Episode Schizophrenia Trial (EUFEST; International Clinical Trials Registry Platform number, ISRCTN68736636), we developed a tool to predict poor versus good treatment outcome (Global Assessment of Functioning [GAF] score ≥65 vs GAF <65, respectively) after 4 weeks and 52 weeks of treatment. To enable the unbiased estimation of the predictive system's generalisability to new patients, we used repeated nested cross-validation to prevent information leaking between patients used for training and validating the models. In pursuit of everyday clinical applicability, we retrained the 4-week outcome predictor with only the top ten predictors of the pooled prediction system and then tested this tool in 108 independent patients with 4-week outcome labels. Discontinuation and readmission to hospital events in patients with predicted poor versus good outcomes were assessed with Kaplan-Meier log-rank analyses, whereas generalised linear mixed-effects models were used to investigate the GAF-based predictions against several clinically meaningful outcome indicators, including treatment adherence, symptom remission, and quality of life. The generalisability of our outcome predictions were estimated with cross-validation (test-fold balanced accuracy [BAC] of 75·0% for 4-week outcomes and 73·8% for and 52-week outcomes), and leave-site-out validation across 44 European sites (BAC of 72·1% for 4-week outcomes and 71·1% for 52-week outcomes). We identified a smaller group of ten predictors still providing a BAC of 71·7% in 108 patients never used for model discovery. Unemployment, poor education, functional deficits, and unmet psychosocial needs predicted both endpoints, whereas previous depressive episodes, male sex, and suicidality additionally predicted poor 1-year outcomes. 52-week predictions identified patients at risk for symptom persistence, non-adherence to treatment, readmission to hospital and poor quality of life. Specifically among these patients, amisulpride and olanzapine showed superior efficacy versus haloperidol, quetiapine, and ziprasidone. Our results suggest that prognostic models operating on brief, patient-reportable pre-treatment data might provide useful insight into individualised outcome trajectories, optimising treatment selection, and targeted clinical trial designs. To embed these tools into real-world care, replication is needed in external first-episode samples with overlapping variables, which are not available in the field at present. The European Group for Research in Schizophrenia.

Correlation between P Wave Dispersion, QRS Duration and QT Dispersion in Hospital Events in Cases of Acute Coronary Syndrome

Background: The acute coronary syndromes encompass a spectrum of unstable angina to trans-mural myocardial infarction. The definition of acute coronary syndrome depends on the specific characteristics of each element of the triad of clinical presentation, electrocardiographic changes and biochemical cardiac markers. Objectives: To assess Correlation between P wave dispersion, QRS duration and QT dispersion in hospital events in patients with Acute Coronary Syndrome [ACS]. Methods: This prospective study was conducted on 60 patients with acute coronary syndrome admitted to critical care units of Alexandria University Hospitals from first of January 2012 to end of August 2012. An informed consent was taken from relatives of every patient included in the study. This study was approved by ethical committee of Alexandria Faculty of Medicine. Results: During the observation up to 5 days, 1 patient [1.6%] developed AF. There was no significant correlation between P wave Dispersion [PD] in the three studied groups and No significant relation between its and the whole complications developed in failed thrombolysis group [p>0.05]. PD alone couldn’t predict AF in this study, as the mean was 20.0 milliseconds, which was too small to predict AF alone.There was no significance difference between QRS duration in the three groups [unstable angina, successful thrombolysis and failed thrombolysis respectively with mean value [75.7 ± 14.02, 75.2 ± 10.88, 73.36 ± 8.81] [p>0.05] and the relationship between the QRS duration and the development of complications was non-significant in this study. This study showed that there was a significant relation among the three groups and highly significant correlation between QTD duration and prediction of complications. It was clear that ICU length of stay was longer in patients with failed thrombolysis in comparison with the other two groups [p<0.05]. Conclusions: Importance of measurements of QT Dispersion to patients with acute coronary syndrome especially at admission. Failed thrombolysis patients should be under close observation and Monitoring till another option is available like coronary intervention.

Correlation between P Wave Dispersion, QRS Duration & QT Dispersion in Hospital Events in Cases of Acute Coronary Syndrome

Back Ground: The acute coronary syndromes encompass a spectrum of unstable angina to transmural myocardial infarction. The definition of acute coronary syndrome depends on the specific characteristics of each element of the triad of clinical presentation, electrocardiographic changes and biochemical cardiac markers. Objectives: To assess Correlation between P wave dispersion, QRS duration & QT dispersion in hospital events in patients with acute coronary syndrome (ACS). Methods: This prospective study was conducted on 60 patients with acute coronary syndrome admitted to critical care units of Alexandria University Hospitals from first of January 2012 to end of August 2012. An informed consent was taken from relatives of every patient included in the study. This study was approved by ethical committee of Alexandria Faculty Of Medicine. RESULTS: During the observation up to 5 days, 1 patient (1.6%) developed AF. There was no significant correlation between P wave dispersion(PD) in the three studied groups& No significant relation between it & the whole complications developed in failed thrombolysis group (p> 0.05). PD alone couldn’t predict AF in this study, as the mean was 20.0 milliseconds, which was too small to predict AF alone. There was no significance difference between QRS duration in the three groups (unstable angina, successful thrombolysis and failed thrombolysis respectively with mean value (75.7 ± 14.02, 75.2 ± 10.88, 73.36± 8.81) (p> 0.05) & the relationship between the QRS duration and the development of complications was non-significant in this study. This study showed that there was a significant relation among the three groups & highly significant correlation between QTD duration and prediction of complications. It was clear that ICU length of stay was longer in patients with failed thrombolysis in comparison with the other two groups (p<0.05). Conclusions: 1- Importance of measurementsof QT Dispersion to patients with acute coronary syndrome especially at admission. 2- Failed thrombolysis patients should be under close observation and monitoring till another option is available like coronary intervention.

Relationship between quantitative cardiac neuronal imaging with ¹²³I-meta-iodobenzylguanidine and hospitalization in patients with heart failure.

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by (123)I-meta-iodobenzylguanidine ((123)I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between (123)I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using (123)I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships.

Costs of hospital events in patients with metastatic colorectal cancer

Background:In the last decade, the number of new agents, including monoclonal antibodies, being developed to treat metastatic colorectal cancer (mCRC) increased rapidly. While improving outcomes, these new treatments also have distinct and known safety profiles with toxicities that may require hospitalizations. However, patterns and costs of hospitalizations of toxicities of these new ‘targeted’ drugs are often unknown.Objective:This study aimed to estimate the costs of hospital events associated with adverse events specified in the ‘Special Warnings and Precautions for Use’ section of the European Medicinal Agency Summary of Product Characteristics for bevacizumab, cetuximab, and panitumumab, in patients with mCRC.Methods:From the PHARMO Record Linkage System (RLS), patients with a primary or secondary hospital discharge code for CRC and distant metastasis between 2000–2008 were selected and defined as patients with mCRC. The first discharge diagnosis defining metastases served as the index date. Patients were followed from index date until end of data collection, death, or end of study period, whichever occurred first. Hospital events during follow-up were identified through primary hospital discharge codes. Main outcomes for each event were length of stay and costs per hospital admission.Results:Among 2964 mCRC patients, 271 hospital events occurred in 210 patients (mean [SD] duration of follow-up: 34 [31] months). The longest mean (SD) length of stay per hospital admission were for stroke (16 [33] days), arterial thromboembolism (ATE) (14 [21] days), wound-healing complications (WHC), acute myocardial infarction (AMI), congestive heart failure (CHF), and neutropenia (all 9 days; SD 5–15). Highest mean (SD) costs per admission were for stroke (€13,500 [€28,800]), ATE (€13,300 [€18,800]), WHC (€10,800 [€20,500]).Limitations:Although no causal link could be identified between any specific event and any specific treatment, data from this study are valuable for pharmacoeconomic evaluations of newer treatments in mCRC patients.Conclusions:Inpatient costs for events in mCRC patients are considerable and vary greatly.

Protein and Energy Intake in Advanced Chronic Kidney Disease: How Much is Too Much?

Uremic wasting is strongly associated with increased risk of death and hospitalization events in patients with advanced chronic kidney disease (CKD). Recent evidence indicates that patients with advanced chronic kidney disease are prone to uremic wasting due to several factors, which include the dialysis procedure and certain comorbid conditions, especially chronic inflammation and insulin resistance or deficiency. While the catabolic effects of dialysis can be readily avoided with intradialytic nutritional supplementation, there are no established alternative strategies to avoid the catabolic consequences of comorbid conditions other than treatment of their primary etiology. To this end, there is no indication that simply increasing dietary protein and energy intake above the required levels based on level of kidney disease is beneficial in patients with advanced chronic kidney disease. However, aside from the potential adverse effects such as uremic toxin production, dietary protein and energy intake in excess of actual needs might be beneficial in maintenance dialysis patients as it may lead to weight gain over time. Clearly, the role of obesity in advanced uremia needs to be examined in detail prior to making any clinically applicable recommendations, both in terms of ''low'' and ''high'' dietary protein and energy intake.

Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the global registry of acute coronary events (grace)

Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the global registry of acute coronary events (grace)

Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE)

ObjectiveTo examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE). BackgroundElevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear. MethodsWe examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST–segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 <6000, Q2 = 6000–9999, Q3 = 10,000–11,999, Q4 >12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables. ResultsIncreasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1–3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2–3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1–4.7; OR for heart failure 2.4, 95% CI 1.8–3.3), non-ST–segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2–3.0; OR for heart failure 1.7, 95% CI 1.1–2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4–5.5; OR for heart failure 2.0, 95% CI 0.9–4.4). ConclusionIn men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.