Lymphopenia and mortality among patients undergoing coronary angiography: Long-term follow-up study

Abstract

Background: Lymphopenia is associated with adverse prognosis in chronic disease states that are related to immune dysregulation. We aimed to determine the association between lymphopenia and mortality in patients presenting to coronary angiography and investigate whether elevated red blood cell distribution width (RDW), an established cardiovascular prognostic marker, further refines risk stratification. Methods: Retrospective analysis of patients undergoing coronary angiography for evaluation or treatment of coronary artery disease between 2003 and 2018. Mortality risk associated with relative (1000-1500/μL) or severe (< 1000/μL) lymphopenia was analyzed using adjusted Cox proportional hazards regression models. Results: Overall, 15,179 patients aged 65 ± 12 years underwent coronary angiography. During a median follow-up of 8 years, 4253 patients died. Compared to normal lymphocyte count, the adjusted hazard ratio (HR) for mortality was 1.31 (95% confidence interval [CI] 1.21-1.41) and 2 1.97 (95% CI 1.75-2.22) for relative and severe lymphopenia, respectively. The increase in mortality associated with severe lymphopenia was significant in patients presenting in the nonacute setting (HR 2.18, 95% CI 1.74-2.73), ST-segment elevation myocardial infarction (STEMI) (HR 1.59, 95% CI 1.15-2.21), or unstable angina/non-STEMI (HR 2.00, 95% CI 1.70-2.34); p-value for interaction 0.626. The association of lymphopenia with mortality remained significant after additional adjustment to RDW. High RDW (> 14.5%) was associated with reduced survival, and it improved the predictive accuracy of lymphocytes count with an increase in Harrell's Concordance statistic from 0.634 (SE = 0.005) to 0.672 (SE = 0.005), p < 0.001. Conclusions: lymphopenia is associated with increased risk of mortality during long-term follow-up in patients undergoing coronary angiography, regardless of the coronary presentation. High RDW may enhance the predictive ability of lymphopenia.

Importance of hematological parameters for micro- and macrovascular outcomes in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

“…Relatively few studies evaluated low absolute lymphocytes count as a prognostic marker [ 16 , 34 – 37 ]; three were in patients with cardiovascular diseases [ 34 – 36 ], two in population-based samples [ 16 , 37 ] and none of them in individuals with diabetes. An observational cohort study showed that low lymphocytes were predictive of all-cause and several cause-specific mortality, including cardiovascular one [ 37 ].…”

Blood cell differential count discretisation modelling to predict survival in adults reporting to the emergency room: a retrospective cohort study

“…This finding is not restricted to COVID-19, as it was described in a retrospective study on 1715 chronic hepatitis C virus patients undergoing a 5-year follow-up 25. Lymphopenia and elevated RDW were associated with long-term mortality risk in 15 179 patients undergoing coronary angiography in both acute and non-acute settings 26. Eosinopenia was reported as a marker of poor outcome in lung disease27 and critically ill patients 28.…”

Blood cell differential count discretization methods to predict survival in acutely ill adults reporting to the emergency room: a retrospective cohort study in 2020

“…This finding is not restricted to COVID-19, as it was described in a retrospective study on 1.715 chronic Hepatitis C virus (HCV) patients undergoing a five-year follow up[25]. Lymphopenia and elevated RDW were associated with long-term mortality risk in 15179 patients undergoing coronary angiography in both acute and non-acute settings[26].…”