European Geriatric Medicine (2018) 9:365–370
Lymphocyte‑to‑white blood cells ratio in older patients experiencing
a rst acute heart failure hospitalization
· David Chivite
· Marta Salvatori
· Rafael Moreno‑Gonzalez
· Albert Ariza
· Xavier Corbella
Received: 9 January 2018 / Accepted: 24 March 2018 / Published online: 9 April 2018
© European Geriatric Medicine Society 2018
Purpose 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 hospitaliza-
tion for acute HF.
Methods 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.
Results 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.
Conclusions 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.
Keywords Heart failure · Lymphocyte · Hospitalization · Older · Mortality
Heart failure (HF) is a major health problem with signiﬁcant
morbidity and mortality . This is especially true among
older patients, who represent an important percentage of HF
cases in the real world .
Several studies have evaluated the prognostic importance
of white blood cell abnormalities in HF patients [3, 4]. Both
total leukocyte count and neutrophilia have been linked to
poor prognosis in patients with HF [4–6]. It has also been
consistently reported that a low lymphocytes count predicts
worse prognosis for both chronic and acute HF [4, 7, 8].
Lymphopenia, idiopathic or secondary, is a common ﬁnding
in older patients and associates with bad outcomes in hospi-
talized patients such as longer hospital stay, in-hospital mor-
tality and 1-year mortality after discharge . More reﬁned
parameters of immune function, the lymphocyte-to-white
blood cells ratio (LWR) or neutrophil-to-lymphocyte ratio,
have also been shown to predict bad outcomes in all ages of
acute HF [5, 9].
* Francesc Formiga
Geriatric Unit, Internal Medicine Department, Universitary
Bellvitge Hospital-IDIBELL, Hospital Universitari de
Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona,
Scuola di Specializzazione in Medicina Interna, Università
degli Studi di Milano, Milan, Italy
Cardiology Service, Universitary Bellvitge
Hospital-IDIBELL, L’Hospitalet de Llobregat, Barcelona,
Hestia Chair in Integrated Health and Social Care, Faculty
of Medicine and Health Sciences, Universitat Internacional
de Catalunya, Barcelona, Spain