Key result
Both the lowest and highest leukocyte counts were associated with a higher risk of all-cause mortality in patients with HFpEF, following a U-shaped curve (highest vs reference quartile HR 1.901).
Why the study?
There was little available evidence regarding the relationship between leukocyte count, a widely used inflammatory marker, and outcomes in HFpEF.
Does leukocyte count predict all-cause mortality and adverse outcomes in patients with HFpEF?
Observational (n=2,898)
Yes
Does leukocyte count predict all-cause mortality and adverse outcomes in patients with HFpEF?
In patients with HFpEF, the association between leukocyte count and adverse outcomes follows a U-shaped curve, with both low and high counts independently predicting higher all-cause mortality.
Answers are grounded in this paper and cite their sources.
May aid mortality risk stratification in HFpEF; leaves open causality and need for prospective trials.
BACKGROUND: Inflammation is a key feature of heart failure including HFpEF. The leukocyte count is a marker of inflammation that is widely used in clinical practice. However, there is little available evidence for the relationship between leukocyte count and the outcomes of HFpEF. METHODS: We analyzed data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. The primary outcome was all-cause mortality, the secondary outcome was composite cardiovascular events and hospitalization for heart failure. Multivariable Cox proportional hazard models were used to compare the risk profiles of patients with leukocyte quartiles, subgroup study divided by sex was also analyzed. RESULTS: The present study included 2898 patients with HFpEF.429 deaths, 671 composite cardiovascular events and 386 hospitalization for heart failure occurred during a mean 3.4 years follow-up. The association between leukocyte count and adverse outcomes followed a U-shaped curve. After multivariable adjustment, the patients with the lowest leukocyte count (Q1) and the highest leukocyte count (Q4) faced higher risk of all-cause death(Q1 vs. Q2, adjusted HR: 1.439; 95% CI: 1.060-1.953, p = 0.020; Q4 vs. Q2, adjusted HR, 1.901; 95%CI: 1.424-2.539, p < 0.001). The subgroup analysis showed a consistent result in female but not male patients. CONCLUSIONS: The association between leukocyte count and risk of adverse outcomes followed a U-shaped curve. Both higher and lower leukocyte count are associated with worse outcomes in patients with HFpEF, which may be attributed to the two sides of inflammation in cardiac remodeling.
No takes yet. Share an insight, caveat, or question.
Zhu et al. (2021) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=2,898). Highest leukocyte count quartile (Q4: > 8.0 × 10^9/l) vs. Reference leukocyte count quartile (Q2: 5.5-6.7 × 10^9/l) was evaluated on All-cause mortality (HR 1.901, 95% CI 1.424-2.539, p=<0.001). Both the lowest and highest leukocyte counts were associated with a higher risk of all-cause mortality in patients with HFpEF, following a U-shaped curve (highest vs reference quartile HR 1.901).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: