@article{3130047,
    title = "Low lymphocyte ratio as a novel prognostic factor in acute heart failure: Results from the Pre-RELAX-AHF study",
    author = "Milo-Cotter, O. and Teerlink, J.R. and Metra, M. and Felker, G.M. and Ponikowski, P. and Voors, A.A. and Edwards, C. and Weatherley, B.D. and Greenberg, B. and Filippatos, G. and Unemori, E. and Teichman, S.L. and Cotter, G.",
    journal = "Cardiology (Switzerland)",
    year = "2011",
    volume = "117",
    number = "3",
    pages = "190-196",
    doi = "10.1159/000321416",
    keywords = "brain natriuretic peptide;  glucose;  placebo;  relaxin, acute heart failure;  aged;  article;  controlled study;  dyspnea;  female;  hospitalization;  human;  lymphocyte count;  major clinical study;  male;  peripheral vascular disease;  priority journal;  prognosis;  systolic blood pressure, Aged;  Female;  Heart Failure;  Humans;  Infusions, Intravenous;  Lymphocyte Count;  Male;  Middle Aged;  Prognosis;  Relaxin",
    abstract = "Background: Previous studies have suggested that a lower lymphocyte ratio (Ly%) in the white blood cell (WBC) differential count is related to worse outcomes in patients with acute heart failure (AHF) and other cardiovascular disorders. Methods: In the Pre-RELAX-AHF study, 234 patients with AHF, systolic blood pressure >125 mm Hg and brain natriuretic peptide ≥350 pg/ml or equivalent were randomized to 1 of 4 intravenous doses of relaxin or placebo and followed up for 6 months following randomization. Complete blood count and differential were performed by a central laboratory at baseline and then daily to day 5 and on day 14. Results: The WBC count by itself was not associated with measures of disease severity or outcome, and patients with Ly% <13% had similar baseline characteristics to patients with Ly% >13%, except for a higher baseline WBC count, elevated baseline glucose, older age and higher rates of peripheral vascular disease. However, patients with Ly% <13% had less improvement of dyspnea, greater worsening of heart failure, longer length of initial hospital stay and fewer days alive and out of hospital. Statistical significance was reached for all-cause death by days 60 and 180 (hazard ratio = 1.11 per percent decrease, 95% confidence interval 1.03-1.19; p = 0.0048). Conclusions: Despite no association with any baseline characteristic known to strongly predict outcome in AHF, low Ly% is associated with less symptom relief and worse in-hospital and postdischarge clinical outcomes. Copyright © 2010 S. Karger AG, Basel."
}