Low Relative Lymphocyte Count Research Articles

Impact of Obesity and Its Associated Comorbid Conditions on COVID-19 Presentation.

BackgroundThere is great variability in clinical presentation of COVID-19 worldwide. The current study evaluated the impact of obesity and its related complications on the course of COVID-19 in Egyptian patients.MethodsWe included 230 COVID-19 Egyptian patients from Tanta City. According to their body-mass index (BMI), patient were divided into three groups: normal weight (BMI <25 kg/m2), overweight (BMI >25–<30 kg/m2), and obese (BMI ≥30 kg/m2). Patients’ glycemic status, lipid profile, and serum levels of acute-phase reactants were assessed. The number of patients receiving intensive care and the number of deaths in each group were counted.ResultsMean values of random blood sugar, serum cholesterol, triglycerides, serum ferritin, erythrocyte-sedimentation rate, LDH, CRP, D-dimer levels, and blood pressure were significantly higher in obese patients (165.6, 129.5, 105, 1,873, 26, 403, 56.45, 977.16 and 142/87, respectively) than in normal-weight (97.2, 103.5, 70.4, 479, 17.4, 252, 23.2, 612.4, and 118.6/76.8, respectively) and overweight patients (111.4, 106.3, 78.13, 491.3, 19.8, 269.27, 25.42, 618.4, and 120.3/79.3, respectively). Lymphopenia was also significantly predominant in the obese group. Multivariate logistic regression analysis revealed that elevated serum triglycerides, total cholesterol, low density–lipoprotein cholesterol, blood pressure, ferritin, CRP, and low relative lymphocyte count were significant risk factors in obese COVID-19 patients.ConclusionObesity and its related complications increase the risk of presenting a more severe form of COVID-19 in Egyptian patients.

Relation of Low Lymphocyte Count to Frailty and its Usefulness as a Prognostic Biomarker in Patients >65 Years of Age With Acute Coronary Syndrome

Low lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low-relative lymphocyte count (Lymph%) and frailty status in patients >65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS >65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent association between Lymph% and Fried≥3 was evaluated by multivariate logistic regression analysis. The associations between Lymph% with long-term all-cause mortality and recurrent admission were evaluated with Cox regression and shared frailty regression, respectively. The mean age of the sample was 78 ± 7 years and 41% were females. The median (interquartile range) of the Lymph% was 21% (15 to 27) and 41% showed Fried≥3. In multivariate analysis, Lymph% was inversely related to the odds of frailty with an exponential increase risk from values below 15% (p = 0.001). Likewise, Lymph% was inverse and independently associated with a higher risk of long-term mortality (p = 0.011), recurrent all-cause (p = 0.020), and cardiovascular readmissions (p = 0.024). In conclusion, in patients >65 years with a recent ACS, low Lymph% evaluated at discharge is associated with a higher risk of frailty. Low Lymph% was also associated with a higher risk of long-term mortality and recurrent admissions beyond standard prognosticators and Fried score.

The Relation between Lymphopenia and Mortality Rate in Elderly COPD Patients

Background: Chronic obstructive pulmonary disease (COPD) become the third most common cause of death and fifth most frequent cause of chronic disability by 2020. It is mainly caused by cigarette smoking, but the reasons why only a proportion (10%–20%) of smokers develops progressive airflow limitation is currently unknown. The disease is characterized by a chronic inflammatory process predominantly in the small airways and lung parenchyma, with increased numbers of macrophages, neutrophils, and T lymphocytes. This inflammation in the small airways is associated with fibrosis and increases with the severity of airflow limitation. Objectives: Is Low relative lymphocyte count was associated with higher mortality in elderly patients with severe COPD? Relative lymphopenia has a homogeneous and strong effect on mortality across the whole follow-up period, but the inherent mechanisms remain to be clarified. This study demonstrates that relative lymphopenia is associated with a poor prognosis in elderly patients with severe COPD. This finding seems worthy of attention because lymphocyte count is a simple, reproducible, widely available and inexpensive prognostic tool.

Red blood cell distribution width, relative lymphocyte count, and type 2 diabetes predict all‑cause mortality in patients with advanced heart failure.

INTRODUCTION Early identification of patients with advanced heart failure (HF) who are at higher risk of poor outcome is an important element of patient management, both from the medical and economic standpoint. OBJECTIVES We sought to determine the association between hematologic parameters assessed on admission and within a 3‑year follow‑up in consecutive patients with advanced HF. We also investigated the association between baseline demographic and clinical data and mortality. PATIENTS AND METHODS We analyzed the data of consecutive patients with advanced HF from the single‑center registry COMMIT‑HF. Patients with hematologic and autoimmune disorders, acute or chronic inflammatory diseases, malignant diseases, incomplete clinical and laboratory data, and those receiving glucocorticoids were excluded from the study. RESULTS We analyzed 785 patients with advanced HF out of the total number of 1798 patients included in the COMMIT‑HF registry between 2009 and 2013. The mean (SD) age of the patients was 61.9 (12.4) years, and 76.8% of them were male. Diabetes (hazard ratio [HR], 1.46; 95% CI, 1.15-1.86; P = 0.002), elevated red blood cell distribution width (RDW; HR, 1.05; 95% CI, 1.04-1.07; P <0.0001), and a low relative lymphocyte count (RLC%; HR, 0.942; 95% CI, 0.928-0.956; P <0.0001) were shown to be independent predictors of death. CONCLUSIONS Our study showed that diabetes is a strong independent predictor of death in patients with advanced HF. RDW and RLC% are simple, accurate, and widely available markers predicting mortality at 3 years in patients with advanced HF.

Prognostic value of the absolute lymphocyte count in patients admitted for acute heart failure

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. 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. 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]. 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.

Relative lymphocyte count as a marker of progression of chronic kidney disease

Although low relative lymphocyte count (RLC) is associated with poor outcomes in patients with chronic kidney disease (CKD), the relationship between low RLC and progression of CKD is poorly defined. The aim of this study was to determine the association between low RLC and the progression of CKD. Between January 2003 and December 2009, 288 CKD patients were analyzed. RLC was calculated as the ratio between lymphocyte and total white blood cell counts. The median RLC was 29.1% [interquartile range (IQR) 24.1-34.1]. When the patients were compared according to a level below or above the median value for RLC, the rate of CKD progression to end-stage renal disease (ESRD) was greater in patients with low RLC count than in patients with high RLC (48 vs. 25%, p < 0.001) during the median follow-up of 5.5 years (IQR 3.5-7.6). The variables found to be predictive of progression to the ESRD included younger age, smoking, diabetes, higher systolic blood pressure, no use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), lower hemoglobin and serum albumin levels, higher low-density lipoprotein cholesterol concentration, presence of proteinuria, and low RLC in the univariate Cox proportional hazards regression analysis. However, after adjustment, younger age, male, higher systolic blood pressure, no use of ACEIs or ARBs, lower hemoglobin and serum albumin concentrations, higher proteinuria, and lower RLC were significantly associated with progression to ESRD in multivariate analysis. Low RLC is independently associated with increased rate of progression in patients with CKD.

Predictive Value of Low Relative Lymphocyte Count in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Background— Low lymphocyte count has been shown to be an independent prognostic marker in heart failure (HF) in the outpatient setting. Limited data exist regarding whether relative lymphocyte count correlates with postdischarge outcomes in patients hospitalized for HF. Methods and Results— We performed a post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, which randomized 4133 patients hospitalized for worsening HF with an ejection fraction ≤40% within 48 hours of admission to tolvaptan or placebo for a median follow-up of 9.9 months. The primary end points of all-cause mortality and cardiovascular mortality or HF hospitalization were analyzed in patients with available baseline complete blood counts (n=3717). Lymphocyte percentage was analyzed as a continuous variable. Times to events were compared using log-rank tests and multivariable Cox regression models. Patients with low lymphocyte percentage tended to be older and had higher rates of comorbid disease (diabetes mellitus, atrial fibrillation, and renal insufficiency). Low lymphocyte counts were associated with wide QRS duration, high natriuretic peptides, and low ejection fraction, blood pressure, and serum sodium. These patients were less likely to receive evidence-based HF medications. After adjusting for 22 known clinical risk factors, a 10% decrease in lymphocytes was associated with an increased hazard of all-cause mortality (adjusted hazard ratio 1.31 [95% CI: 1.14–1.150], P &lt;0.001) and cardiovascular mortality or HF hospitalization (adjusted hazard ratio 1.14 [95% CI: 1.04–1.25], P =0.007) in the first 100 days postdischarge. Lymphopenia during hospitalization normalizes in majority of patients in the early postdischarge period. Conclusions— Low relative lymphocyte count during hospitalization for HF is an independent predictor of poor outcomes in the early postdischarge period, beyond traditional prognostic indicators.

Effectiveness of the Relative Lymphocyte Count to Predict One-Year Mortality in Patients With Acute Heart Failure

Several works have endorsed a significant role of the immune system and inflammation in the pathogenesis of heart failure. As indirect evidence, an association between a low relative lymphocyte count (RLC%) and worse outcomes found in this population has been suggested. Nevertheless, the role of RLC% for risk stratification in a large and nonselected population of patients with acute heart failure (AHF) has not yet been determined. Thus, the aim of this study was to determine the association between low RLC% and 1-year mortality in patients with AHF and consequently to define whether it has any role for early risk stratification. A total of 1,192 consecutive patients admitted for AHF were analyzed. Total white blood cell and differential counts were measured on admission. RLC% (calculated as absolute lymphocyte count/total white blood cell count) was categorized in quintiles and its association with all-cause mortality at 1 year assessed using Cox regression. At 1 year, 286 deaths (24%) were identified. A negative trend was observed between 1-year mortality rates and quintiles of RLC%: 31.5%, 27.2%, 23.1%, 23%, and 15.5% in quintiles 1 to 5, respectively (p for trend <0.001). After thorough covariate adjustment, only patients in the lowest quintile (<9.7%) showed an increased risk for mortality (hazard ratio 1.76, 95% confidence interval 1.17 to 2.65, p = 0.006). When RLC% was modeled with restricted cubic splines, a stepped increase in risk was observed patients in quintile 1: those with RLC% values <7.5% and <5% showed 1.95- and 2.66-fold increased risk for death compared to those in the top quintile. In conclusion, in patients with AHF, RLC% is a simple, widely available, and inexpensive biomarker, with potential for identifying patients at increased risk for 1-year mortality.

Usefulness of Relative Lymphocyte Count as an Independent Predictor of Death/Urgent Transplant in Heart Failure

The usefulness of low relative lymphocyte count as an independent predictor of death/urgent transplant in patients with heart failure (HF) and the association between low relative lymphocyte count and neurohormone and cytokine activation were investigated. Relative lymphocyte count, clinical variables, neurohormones, and cytokines were measured in 129 outpatients with HF. Follow-up extended to a mean of 3.0 +/- 1.2 years for death/urgent transplant. Low relative lymphocyte count was independently associated with a 3.4-fold increased risk of death/urgent transplant. Relative lymphocyte count was positively associated with hemoglobin and inversely associated with age, jugular venous pressure, creatinine, leukocyte count, and soluble tumor necrosis factor receptor-1. There was only a borderline inverse association with cortisol levels during evening hours.

Low Relative Lymphocyte Count Flags Cardiomyopathy Risk

Low Relative Lymphocyte Count Flags Cardiomyopathy Risk

Relative lymphocyte count is an independent predictor of death/urgent transplant in heart failure

Objectives: Our aims were 1) to determine if low relative lymphocyte count (%L) is an independent predictor of death/urgent transplant and 2) to explore if the risk associated with low %L can be explained by neurohormones or cytokines. BACKGROUND Low %L is correlated with mortality in HF. However, there is little data on whether it is an independent predictor or potential mechanisms. Methods: Using a prospective cohort design, we evaluated the relationship between %L and mortality/urgent transplant in 129 outpatients referred to an end-stage HF clinic. Associations between %L and cytokines, neurohormones and clinical variables were examined to explore potential mediators or explanations for this relationship. Results: Patients with lower %L were older, more likely to have ischemic HF, lower blood pressure, higher creatinine, more comorbidites, lower peak VO2, higher JVP, lower hemoglobin, and higher leukocyte count. There was a positive association between %L and hemoglobin and inverse associations between %L and sTNF receptor 1, creatinine, JVP, leukocyte count, and age. There was a borderline inverse association with evening cortisol. The hazard ratio for mortality/urgent transplant in patients with %L<21.5 (median) was 6.61 (95% CI 2.5−17.3, p=0.0001). In a multivariate adjustment which included neurohormonones, cytokines, and cortisol, patients with low %L still had a more than 3-fold higher risk of death/urgent transplant (HR=3.4, 95% 1.1−10.8, p=0.04). %L was also strongly predictor when evaluated as a continuous variable, with more than 2-fold higher risk for each standard deviation lower %L (HR=2.59, 95% CI=1.44−4.69, p=0.002 multivariate model). Endotoxin induces apoptosis in erythroid cells, myocytes, and lymphocytes. We propose that low %L may be a marker of elevated circulating endoxotin levels. Unfortunately, endotoxin was not measured in this study. Conclusions: In patients with moderate to severe HF, low %L is an independent predictor of death/urgent transplant in HF. Further investigation into causative mechanisms for low %L in HF is warranted.Survival free of urgent transplant was markedly lower in patients with a low% lymphocyte count.

Relative lymphocyte count: A prognostic indicator of mortality in elderly patients with congestive heart failure

Background A reduction in the relative lymphocyte count is a marker of the stress response; however, its prognostic value remains undetermined. The objective of this study was to investigate the predictive value of the relative lymphocyte count for survival in elderly patients with congestive heart failure (CHF). Methods and Results One thousand two hundred seventy-four consecutive patients above the age of 65 years hospitalized with heart disease were enrolled in the CHF Italian Study and followed up for 3 years. Of these, 413 patients were excluded because of factors that could affect the lymphocyte count. Of the remaining 861 patients, 423 (49%) met the criteria for the diagnosis of CHF (mean age 76 ± 7 years, 51% men), of whom 162 patients (38%) had a relative lymphocyte count ≤20%. The 3-year all-cause mortality in patients with CHF and a relative lymphocyte count ≤20% was 64% compared with 40% in patients with a relative lymphocyte count >20% (P <.0001). The age- and sex-adjusted hazard ratio for death in patients with CHF and low relative lymphocyte count was 1.76 (95% confidence interval 1.34-2.32, P =.0001). After adjustment for baseline differences and variables associated with or known to affect lymphocyte count, the hazard ratio remained significantly different from 1.0 (hazard ratio 1.73, 95% confidence interval 1.21-2.48, P =.0026). Conclusion A low relative lymphocyte count is an independent marker of poor prognosis in elderly patients with CHF. The relative lymphocyte count is a simple, accurate, widely available, and inexpensive marker that can help to identify elderly patients with CHF who are at increased risk for mortality. The pathophysiologic mechanism of this observation remains to be determined. (Am Heart J 2001;142:167-73.)

Stress and adaptation responses to repeated acute acceleration.

Study in which groups of adult male chickens (single-comb white leghorn) were exposed daily to acceleration (centrifugation) of 2 or 3 G for 10 min, 1, 4, 8, 12, 16, and 24 hr (continuously), or 0 time (controls). After approximately five months of this intermittent treatment (training), the birds were exposed to continuous accelerations of the same G force (intensity). The degree of stress and adaptation of each bird was determined by survival and relative lymphocyte count criteria. Intermittent training exposures of 2 G developed levels of adaptation in birds directly proportional to the duration of their daily exposure. Intermittent training periods at 3 G, however, produced a physiological deterioration in birds receiving daily exposures of 8 hr or more. Adaptive benefits were found only in the 1- and 4-hr-daily intermittent 3-G exposure groups. Exposure to 3 G produced an immediate stress response as indicated by a low relative lymphocyte count which returned to control (preexposed) values prior to the next daily acceleration period in the 10-min, 1-hr, and 4-hr groups. This daily recovery period from stress appeared to be necessary for adaptation as opposed to deterioration for the more severe environmental (3 G) alteration.