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Utility of the Neutrophil to Lymphocyte Ratio in Predicting In-hospital Mortality in Patients That Received Levosimendan Treatment for Acute Decompensated Heart Failure

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Date
2013-10-01T00:00:00Z
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Tasal, Abdurrahman
Surgit, Ozgur
BACAKSIZ, AHMET
Goktekin, Omer
Uyarel, Huseyin
Ergelen, Mehmet
Erdogan, Ercan
Kul, Seref
Sonmez, Osman
Turfan, Murat
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Abstract
Aim The aim of the study was to investigate the effect of levosimendan infusion on hematological variables in patients with acute heart failure. Also, predictive value of these variables over in hospital mortality evaluated. Methods Two hundred and nineteen patients (168 male, 51 female, mean age 63.2±12.7 years) with acute exerbation of advanced heart failure (ejection fraction ≤35%) were included in this study. Levosimendan was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0,1 μg/kg/min for 24 hours. Changes of hematological variables between admission and on third day after levosimendan infusion were evaluated. Categorical variables were expressed as frequencies and percentages. Continuous variables were compared using analysis of variance and Kruskal-Wallis tests for those with normal and skewed distributions, respectively. Chi-square tests were used to compare categorical variables. Univariate and multivariate Cox regression models were used to evaluate the independent association of different hematological variables with in-hospital mortality. Results Table 1 demonstrated the baseline demographical and laboratory characteristics of the patients. After levosimendan therapy, significant decrease in WBC and neutrophil counts and increase in lymphocyte count. As a result, neutrophil to lymphocyte ratio (NLR) decreased. Compared to patients that survived, in patients who died during in-hospital stay, these hematological changes not occurred ( Table 2 ). Δ NLR detected as independent predictor of in hospital mortality when other hematological variables associated with mortality analysed in the multivariate logistic regression analysis (R2=0.094, p=0.003). Conclusion Our study showed that levosimendan treatment is associated with significant changes in hematological variables in patients with acute exacerbation of advanced heart failure. The difference between baseline and post-treatment NLR is independent predictor of in hospital mortality.
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Heart failure
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Tasal A., Surgit O., BACAKSIZ A., Goktekin O., Uyarel H., Ergelen M., Erdogan E., Kul S., Sonmez O., Turfan M., et al., -Utility of the Neutrophil to Lymphocyte Ratio in Predicting In-hospital Mortality in Patients That Received Levosimendan Treatment for Acute Decompensated Heart Failure-, 29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation, Antalya, Türkiye, 26 - 29 Ekim 2013, cilt.62
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