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Background
Acute heart failure (AHF) is a heterogeneous syndrome that comprises the activation
of multiple counter-regulatory processes including the immune and inflammatory pathways,
which worsen the prognosis. Recent data have provided novel insights into the role
of the immune and inflammatory systems in the pathogenesis of heart failure (HF),
and low lymphocyte count has been proposed as an easily obtained marker of systemic
inflammation that has shown a significant association with poor outcomes in this setting.
Although the specific pathophysiological pathway underlying the occurrence of lymphocytopenia
in HF remain incompletely understood, portal congestion has been involved into impaired
leukocyte distribution and altered lymphocyte behavior. However, the associations
between lymphocytopenia and ultrasound surrogates for portal congestion have never
been reported in AHF. In the current study, we aimed to: characterize the clinical
and biochemical variables associated with a low lymphocyte count on admission and
at discharge in patients with AHF; assess the potential associations between lymphocyte
count and ultrasound surrogates for portal congestion; and explore the relationships
between lymphocyte count at discharge and long-term outcomes in AHF.
Methods
Clinical, biological and ultrasound assessments were prospectively obtained at the
time of hospital admission and at discharge, after decongestive therapy. Patients
were compared according to tertiles of absolute lymphocyte count at baseline (very
low,<0.87; low,0.87-1.2; normal,>1.2 × 109/L). Right ventricular (RV) function was
assessed using tricuspid annular plan systolic excursion (TAPSE). Doppler-derived
portal vein pulsatility index (PVPI) was used as a surrogate for portal congestion.
Results
103 patients with AHF were prospectively assessed. At baseline, mean absolute lymphocyte
count was 1.1 ± 0.6 × 109/L, and 69% of patients had a lymphocyte count below local
normal range (1.3 to 4.5 × 109/L). Patients with baseline very low lymphocyte count
were older, had more advanced disease and higher PVPI when compared with those in
the higher tertiles (all p<0.05). Very low lymphocyte count at baseline was associated
with age (OR 1.098), PVPI (OR 1.026) and TAPSE (OR 0.865, all p<0.05). PVPI remained
the only determinant of lymphocytopenia at the time of discharge (OR 1.033, p<0.05).
In a Cox model, lymphocytopenia at discharge was significantly associated with all-cause
of mortality (HR 4.796, p<0.05) after adjusting for age, sex, left ventricular ejection
fraction and hemoglobin.
Conclusions
Low lymphocyte count in patients hospitalized for AHF is strongly associated with
RV dysfunction and ultrasound markers of portal congestion. Whether this association
supports the role of portal congestion as a pathophysiological mechanism directly
involved in lymphocytopenia in AHF, or whether these two features only reflect a more
advanced disease remains to be determined.
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Copyright
© 2020 Published by Elsevier Inc.
