European Geriatric Medicine

, Volume 9, Issue 3, pp 365–370 | Cite as

Lymphocyte-to-white blood cells ratio in older patients experiencing a first acute heart failure hospitalization

  • Francesc Formiga
  • David Chivite
  • Marta Salvatori
  • Rafael Moreno-Gonzalez
  • Albert Ariza
  • Xavier Corbella
Research Paper



Low lymphocyte counts are related to poor health results in heart failure (HF) patients. We assess whether a low lymphocyte-to-white blood cells ratio (LWR) is related to 1-year mortality in older patients experiencing a first hospitalization for acute HF.


We evaluated 859 patients > 75 years of age admitted within a 33-month period because of a first episode of acute HF. Patients were divided into four groups according to LWR quartiles.


Patients’ mean age was 83.5 ± 5.5 years and their median LWR was 16.7%. After 1 year of follow-up 270 patients (31.43%) died. Mean LWR values were significatively lower in the group of patients who died (15.1 vs. 17.4%; p = 0.001). Mortality rates were significantly higher in the lower LWR quartile either at 1 month, 3 months, and 1 year after the index acute HF episode. The univariate logistic regression analysis identified the LWR (either as quartiles or continuous variable) to be independently associated with higher risk of 1-year post-discharge mortality. Multivariate analysis confirmed this association (HR for LWR as a quartiles variable 1.525; 95% CI 1.161–2.003 and for LWR as a continuous variable 1.145; 95% CI 1.069–1854) besides older age, a higher comorbidity and higher admission potassium.


As is the case in other HF scenarios, a simple routine admission laboratory test such as lymphocyte count can independently predict 1-year mortality for older patients hospitalized for first time due to acute HF.


Heart failure Lymphocyte Hospitalization Older Mortality 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study conformed to the principles outlined in the Declaration of Helsinki and the ethics committee of the Bellvitge Universitari Hospital approved the overall protocol [PR2016/16].

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Franco J, Formiga F, Chivite D, RICA investigadors et al (2015) New onset heart failure—clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study. Eur J Intern Med 26:357–362CrossRefPubMedGoogle Scholar
  2. 2.
    Zarrinkoub R, Wettermark B, Wändell P, Mejhert M, Szulkin R, Ljunggren G (2013) The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. Eur J Heart Fail 15:995–1002CrossRefPubMedGoogle Scholar
  3. 3.
    Rubio-Rivas M, Formiga F, Grillo S, Gili F, Cabrera C, Corbella X (2016) Lymphopenia as prognostic factor for mortality and hospital length of stay for elderly hospitalized patients. Aging Clin Exp Res 28:721–727CrossRefPubMedGoogle Scholar
  4. 4.
    Vaduganathan M, Greene SJ, Butler J et al (2013) The immunological axis in heart failure: importance of the leukocyte differential. Heart Fail Rev 18:835–845CrossRefPubMedGoogle Scholar
  5. 5.
    Milo-Cotter O, Felker GM, Uriel N et al (2011) Patterns of leukocyte counts on admissions for acute heart failure—presentation and outcome—results from a community based registry. Int J Cardiol 148:17–22CrossRefPubMedGoogle Scholar
  6. 6.
    Novack V, Pencina M, Zahger D et al (2010) Routine laboratory results and thirty day and one-year mortality risk following hospitalization with acute decompensated heart failure. PLoS One 5:e12184CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Milo-Cotter O, Teerlink JR, Metra M et al (2010) Low lymphocyte ratio as a novel prognostic factor in acute heart failure: results from the Pre-RELAX-AHF study. Cardiology 117:190–196CrossRefPubMedGoogle Scholar
  8. 8.
    Núñez J, Núñez E, Miñana G et al (2011) Effectiveness of the relative lymphocyte count to predict one-year mortality in patients with acute heart failure. Am J Cardiol 107:1034–1039CrossRefPubMedGoogle Scholar
  9. 9.
    Uthamalingam S, Patvardhan EA, Subramanian S et al (2011) Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 107:433–438CrossRefPubMedGoogle Scholar
  10. 10.
    Formiga F, Masip J, Chivite D, Corbella X (2017) Applicability of the heart failure readmission risk score: a First European Study. Int J Cardiol 236:304–309CrossRefPubMedGoogle Scholar
  11. 11.
    Acanfora D, Gheorghiade M, Trojano L, Furgi G, Pasini E, Picone C et al (2001) Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure. Am Heart J 142:167–173CrossRefPubMedGoogle Scholar
  12. 12.
    Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F (2006) The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med 24:451–454CrossRefPubMedGoogle Scholar
  13. 13.
    Levy WC, Mozaffarian D, Linker DT et al (2006) The Seattle heart failure model: prediction of survival in heart failure. Circulation 113:1424–1433CrossRefPubMedGoogle Scholar
  14. 14.
    Dick SA, Epelman S (2016) Chronic heart failure and inflammation: what do we really know? Circ Res 119:159–176CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  • Francesc Formiga
    • 1
  • David Chivite
    • 1
  • Marta Salvatori
    • 2
  • Rafael Moreno-Gonzalez
    • 1
  • Albert Ariza
    • 3
  • Xavier Corbella
    • 1
    • 4
  1. 1.Geriatric Unit, Internal Medicine DepartmentUniversitary Bellvitge Hospital-IDIBELL, Hospital Universitari de BellvitgeBarcelonaSpain
  2. 2.Scuola di Specializzazione in Medicina InternaUniversità degli Studi di MilanoMilanItaly
  3. 3.Cardiology ServiceUniversitary Bellvitge Hospital-IDIBELLBarcelonaSpain
  4. 4.Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health SciencesUniversitat Internacional de CatalunyaBarcelonaSpain

Personalised recommendations