Relation of an elevated white blood cell count after percutaneous coronary intervention to long-term mortality

Increased inflammatory markers are associated with a poor prognosis after percutaneous coronary intervention. Leukocytes play a key role in inflammation, and an increase in white blood cell (WBC) counts is a nonspecific marker of inflammation. In patients undergoing percutaneous coronary intervention, baseline WBC counts independently predict long-term mortality. In a pooled cohort of patients from the Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC), the Evaluation in PTCA to Improve Long-term Outcome with abciximab Glycoprotein IIb/IIIa blockade (EPILOG), and Evaluation of Platelet IIb/IIIa inhibitor for STENTing (EPISTENT) trials, postprocedural WBC counts were also found to be an independent predictor of long-term mortality.     

白细胞计数与非ST段抬高急性冠状动脉综合征患者的预后关系

目的　研究白细胞计数 (WBC)与非 ST段抬高急性冠状动脉综合征 (NSTACS)患者预后的关系。方法　 348例非ST段抬高急性冠状动脉综合征患者入选 ,并进行冠状动脉造影以确定治疗方法。根据入院时的白细胞计数按照四分位法将患者分成四组。结果　各组的白细胞计数分别是 <6 .8× 10 9/ L,6 .8～ 8.0× 10 9/ L,8.0～ 10 .0× 10 9/ L 和 >10 .0× 10 9/ L。第四组的患者在住院期间和随访期间的死亡率明显高于其他三组 ,P=0 .0 0 3和 P<0 .0 0 1。结论　白细胞计数是一项经济和方便的预后指标 ,可用于判断非 ST段抬高急性冠状动脉综合征患者的预后。     

Prognostic value of elevated white blood cell count in hypertension

BACKGROUND: Chronic low-grade inflammation may contribute to vascular injury and atherogenesis, and has been described in association to high blood pressure (BP). However, as yet the prognostic significance of white blood cell (WBC) count in the setting of uncomplicated hypertension has not been investigated. METHODS: In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, 1617 white patients with essential hypertension (aged 49 +/- 12 years, 55% men) without prevalent cardiovascular or renal disease underwent off-treatment baseline clinical evaluation and were then followed up for 11 years (average 4.9 years). RESULTS: The WBC count had a direct association with smoking status, serum triglycerides, body mass index, and 24-h BP, and an inverse one with age (all P < .05). During follow-up, 146 patients developed a major fatal or nonfatal cardiovascular event (1.9 events per 100 patient-years). Patients who will develop a cardiovascular event had a higher WBC count (7.08 +/- 1.6 v 6.68 +/- 1.6 x 10(9) cells/L, P = .004). Event rate increased progressively from the first to the fourth quartile of WBC count distribution (1.2, 1.8, 1.9, and 2.3 events per 100 patient-years; P < .01 by log-rank test). After adjustment (Cox model) for the effect of age, gender, diabetes, serum cholesterol, glomerular filtration rate, smoking, left ventricular hypertrophy, and 24-h systolic BP, cardiovascular event risk increased by 24% (95% confidence interval +4% to +48%; P = .019) for each 2 x 10(9) cells/L increase in WBC. CONCLUSIONS: After adjustment for average 24-h BP, established risk factors and target organ damage, an elevated WBC count remains an independent predictor of cardiovascular morbidity in hypertensive patients.     

Effect of statins and white blood cell count on mortality in patients with ischemic left ventricular dysfunction undergoing percutaneous coronary intervention

BACKGROUND: While morbidity and mortality were shown to be increased in the setting of an elevated white blood cell (WBC) count for patients with acute coronary syndrome, the impact of statin therapy on mortality for patients with an elevated WBC count is unknown in high-risk patients with coronary artery disease. HYPOTHESIS: The goal of this study was to determine whether statin therapy improved survival in patients with elevated WBC count undergoing percutaneous coronary intervention (PCI) with preexisting left ventricular (LV) dysfunction, a population at high risk for adverse outcomes. METHODS: We retrospectively evaluated consecutive patient procedures performed at our institution from 1996 through 1999. Patients had a technically adequate angiographic left ventriculogram with a calculated ejection fraction (EF) < or = 50%. Patients with prior coronary artery bypass graft were excluded. Mortality data were retrieved using the U.S. Social Security Death Index. Follow-up ranged from 3.5 to 6.5 years. Means are provided with +/- standard deviation, and p values < 0.05 were considered significant. RESULTS: Of the study population of 238 patients (average EF 39 +/- 9.8%, mean age 57.5 +/- 12 years, 68% men) 61% underwent PCI for a recent myocardial infarction, 68% received stents, and 65% were discharged on statins. Mean WBC count was 9,000 +/- 3,100 cells/mm3, with 28% of patients having a WBC > or = 10,000 cells/mm3. During follow-up, 27% of our population died. Patients with a WBC > or = 10,000 had worse survival than patients with WBC < 10,000 (1-year survival: 86 vs. 96%, p < 0.05; 3-year survival: 79 vs. 89%, p < 0.05). Survival was significantly improved in patients on statin therapy regardless of WBC count, but the greatest benefit tended to be in patients with WBC > or = 10,000 (WBC > or = 10,000; odds ratio [OR] 5.14, 95% confidence interval [CI] 1.44-19.0, WBC < 10,000; OR 2.79,95% CI 1.13-7.1). Proportional hazard regression analysis demonstrated that both statin therapy and WBC count predicted mortality. CONCLUSION: Patients undergoing PCI with LV dysfunction discharged on statins had improved survival regardless of WBC count, with a trend for greater improvement in patients with elevated WBC counts. In addition, WBC count predicts mortality in this high-risk population with LV dysfunction undergoing PCI.     

Prognostic value of white blood cell count in acute myocardial infarction: long-term mortality

INTRODUCTION AND OBJECTIVES: Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into 3 groups: WBC1 (count, <10 x 103 cells/mL), WBC2 (count, 10-14.9 x 10(3) cells/mL), and WBC3 (count, > or =15x10(3) cells/mL). All-cause mortality was recorded during a median follow-up period of 10+/-2 months. The relationship between WBC and mortality was assessed by Cox regression analysis for both types of AMI. RESULTS: Long-term mortality during follow-up was 18.5% in non-STEMI patients and 19.9% in STEMI patients. In non-STEMI patients, the adjusted hazard ratios for those in the WBC3 and WBC2 groups compared with those in the WBC1 group were 2.07 (1.08-3.94; P=.027) and 1.61 (1.03-2.51; P=.036), respectively. The corresponding figures in STEMI patients were 2.07 (1.13-3.76; P=.017) and 2.22 (1.35-3.63; P=.002), respectively. CONCLUSIONS: WBC on admission was an independent predictor of long-term mortality in both non-STEMI and STEMI patients.     

Elevated white blood cell count is associated with arterial stiffness

Background and aimsWhite blood cell (WBC) count, a usual marker of systemic inflammation, is known to be associated with atherosclerotic cardiovascular disease. The aim of the present study was to determine the association of WBC count with arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV).Methods and resultsWe examined the association between WBC count and baPWV in 788 Korean adults (375 men, 413 women) in a health examination program. The odds ratios for a high baPWV were calculated using multivariate logistic regression analysis after adjusting for confounding variables across WBC count quartiles (Q1: ≤5190, Q2: 5200–6080, Q3: 6090–7310, and Q4: ≥7320 cells/mm³). A high baPWV was defined as more than 1440 cm/s (>75th percentile).Age-adjusted baPWV mean values gradually increased with WBC quartiles (Q1 = 1294, Q2 = 1322, Q3 = 1347, and Q4 = 1367 cm/s). The odds ratios (95% CI) for a high baPWV in each WBC count quartile were 1.00, 1.34 (0.61–3.00), 2.20 (0.96–5.06), and 2.69 (1.15–6.47) after adjusting for age, sex, cigarette smoking, alcohol intake, regular exercise, body mass index (BMI), mean arterial blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, γ-glutamyltransferase (GGT), and uric acid.ConclusionThese findings indicate that elevated WBC count is associated with arterial stiffness. Accordingly, early detection of an elevated WBC count is important for arterial function and the assessment of cardiovascular risk.     

老年急性心肌梗死患者白细胞计数与心脏功能及在院死亡率的关系

目的探讨老年ST段抬高急性心肌梗死(STEAMI)患者外周血白细胞(WBC)计数与住院期间心功能和在院死亡率的关系。方法686例STEAMI患者查血常规后,分为高白细胞组(WBC>10×109/L)和正常白细胞组(WBC<10×109/L),观察住院期间的死亡情况,其中476例检查二维超声心动图。结果高白细胞组的死亡率和心衰(Killip分级)发生率明显高于正常白细胞组。高白细胞组的射血分数(EF)和左室短轴缩短率(FS)均低于正常白细胞组。溶栓后临床指标再通患者高白细胞组EF明显低于正常白细胞组,而补救PCI患者高白细胞组EF、FS与正常白细胞组无统计学差异。相关分析发现,WBC计数与EF和FS呈负相关。结论老年STEAMI患者WBC计数与心功能呈负相关,WBC升高是心衰和死亡率增加的预测指标。     

Effect of both elevated troponin-I and peripheral white blood cell count on prognosis in patients with suspected myocardial injury

We found a high white blood cell count (>11,000/mul) to be of additive prognostic value to high troponin-I levels in predicting risk of recurrent nonfatal myocardial infarctions and all-cause mortality in patients who present with acute coronary syndromes and non-ST-elevation myocardial infarctions. A high troponin-I level or white blood cell count increased the odds ratio of an event to 2.2 (95% confidence interval 1.0 to 4.73, p = 0.05), but high values for the 2 markers increased the odds ratio to 4.5 (95% confidence interval 1.42 to 14.21, p = 0.01).     

White blood cell count and mortality in patients with acute pulmonary embolism

Although associated with adverse outcomes in other cardiovascular diseases, the prognostic value of an elevated white blood cell (WBC) count, a marker of inflammation and hypercoagulability, is uncertain in patients with pulmonary embolism (PE). We therefore sought to assess the prognostic impact of the WBC in a large, state‐wide retrospective cohort of patients with PE. We evaluated 14,228 patient discharges with a primary diagnosis of PE from 186 hospitals in Pennsylvania. We used random‐intercept logistic regression to assess the independent association between WBC count levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient and hospital characteristics. Patients with an admission WBC count <5.0, 5.0–7.8, 7.9–9.8, 9.9–12.6, and >12.6 × 10⁹/L had a cumulative 30‐day mortality of 10.9%, 6.2%, 5.4%, 8.3%, and 16.3% (P < 0.001), and a readmission rate of 17.6%, 11.9%, 10.9%, 11.5%, and 15.0%, respectively (P < 0.001). Compared with patients with a WBC count 7.9–9.8 × 10⁹/L, adjusted odds of 30‐day mortality were significantly greater for patients with a WBC count <5.0 × 10⁹/L (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14–2.03), 9.9–12.6 × 10⁹/L (OR 1.55, 95% CI 1.26–1.91), or >12.6 × 10⁹/L (OR 2.22, 95% CI 1.83–2.69), respectively. The adjusted odds of readmission were also significantly increased for patients with a WBC count <5.0 × 10⁹/L (OR 1.34, 95% CI 1.07–1.68) or >12.6 × 10⁹/L (OR 1.29, 95% CI 1.10–1.51). In patients presenting with PE, WBC count is an independent predictor of short‐term mortality and hospital readmission. Am. J. Hematol. 88:677–681, 2013. © 2013 Wiley Periodicals, Inc.     

Prognostic implications of elevated whole blood choline levels in acute coronary syndromes

Troponins I and T represent the current biomarker standard for diagnosis of myocardial infarction. Even small increases of cardiac troponins have prognostic implications, but not all patients at risk are correctly classified, particularly at admission. We identified elevated whole-blood choline as a promising marker and performed a prospective study of 327 patients with a suspected acute coronary syndrome that focused on the analysis of troponin-negative patients. Diagnostic classification of patients and the definition of troponin cutoffs were performed according to the new European Society of Cardiology/American College of Cardiology criteria. Blood was sampled serially and choline was measured using high-performance liquid chromatography mass spectrometry in whole blood. Patients were followed for 30 days. In patients with negative troponin I test results at admission (n = 250), choline was a predictor of cardiac death and nonfatal cardiac arrest (hazard ratio 6.0, p = 0.003), life-threatening arrhythmias (hazard ratio 3.75, p = 0.004), heart failure (hazard ratio 2.87, p = 0.002), and coronary angioplasty (hazard ratio 2.57, p = 0.001). In multivariate analysis of troponin-negative patients, choline was the strongest predictor of cardiac death or arrest (odds ratio 6.05, p = 0.01). Choline was not a marker for myocardial necrosis but indicated high-risk unstable angina in patients without acute myocardial infarction (sensitivity 86.4%, specificity 86.2%). Thus, an increased concentration of choline at hospital admission is a predictor of adverse cardiac events in patients with suspected acute coronary syndromes. Whole blood choline may be useful for early risk stratification of these patients, particularly if troponin results are negative on admission.     

Differential white blood cell count and all-cause mortality in the Korean elderly

The circulating white blood cell (WBC) count has been considered a good biomarker of systemic inflammation, but the predictive value of this inexpensive and universally obtained test result has not been fully explored in the elderly. The objective of this study was to assess the independent association of WBC count and its individual components with mortality in an elderly population. We studied a total of 9996 participants (age ≥ 65 years) who underwent routine health examinations at the 2 healthcare centers affiliated with Seoul National University. Mortality data were obtained from the National Statistics Office of Korea. The mean age of the study population was 69.7 (SD 4.3) years, and 5491 of the subjects (54.9%) were male. The median length of follow-up was 44.9 months (range, 1.2–78.7 months). There were 118 deaths (1.2%) during the follow-up period. The leading cause of death was cancer. Compared with the survivors, the deceased subjects were older, predominantly male, had increased levels of inflammatory markers, and had poor nutritional status. A significant difference in mortality was identified among patients in different WBC and WBC subtype quartile groups. Cox proportional hazards analysis indicated that monocyte count (HR: 5.18, 95% CI: 2.44–11.02) was a strongest predictor of all-cause mortality than total WBC count (HR: 1.57, 95% CI: 0.88–2.80), granulocyte count (HR: 2.11, 95% CI: 1.15–3.88), and lymphocyte count (HR: 1.11, 95% CI: 0.66–1.86), even after adjusting for possible confounding variables. Monocyte counts were associated with an increased risk of cardiovascular and cancer-related mortality in the elderly population. In conclusion, the total WBC count is an independent predictor of mortality in older adults, but the monocyte subtype provides greater predictive ability.     

Predictive value of elevated white blood cell count in patients with preexisting coronary heart disease: the Bezafibrate Infarction Prevention Study

BACKGROUND: Inflammation is implicated in the pathogenesis of atherosclerosis and acute coronary syndromes. White blood cell (WBC) count increases during infections and inflammatory illnesses and has been shown to predict coronary heart disease (CHD) independent of traditional cardiovascular risk factors. This apparent association may reflect a relationship between the WBC count and other coronary risk factors. Studies in patients with CHD are scarce and give conflicting results. The aim of the present study was to investigate the association between WBC count and subsequent coronary events and total mortality in a large cohort of patients with CHD. METHODS: We evaluated the relationship between WBC count and 6-year risk of coronary events and mortality in a large cohort of patients with chronic CHD who were enrolled in a secondary prevention study of bezafibrate. RESULTS: In univariate analysis, WBC count was associated with an elevated 6-year risk of myocardial infarction, cardiac death, and total mortality. On multivariate adjustment, the positive association with risk of myocardial infarction and cardiac death was eliminated, but WBC count remained predictive of total mortality: relative risk, 1.47; 95% confidence interval, 1.13 to 1.92, in the upper tertile of WBC count (as compared with the lowest). For every 1000/ microL increase in WBC count, risk of total death increased by 6% (relative risk, 1.06; 95% confidence interval, 1.03-1.10). CONCLUSIONS: Elevated WBC count in patients with CHD was associated with higher long-term risk of all-cause mortality. This excess risk of mortality was not due to cardiac causes.     

Systolic blood pressure on admission predicts in-hospital mortality among patients presenting with acute coronary syndromes: the Greek study of acute coronary syndromes

The authors sought to evaluate whether the level of systolic blood pressure (SBP) on hospital admission is an independent prognostic factor for in-hospital mortality of patients hospitalized with acute coronary syndrome (ACS). From October 2003 to September 2004, 2172 consecutive patients with ACS were included in the study (76% men). The in-hospital mortality rate was 3.2% in male and 5.7% in female patients (overall, 82 deaths; P=.009). An inverse association was observed between in-hospital mortality rate and levels of SBP (<100 mm Hg, death rate 17.8%; 100-120 mm Hg, 3.7%; 120-140 mm Hg, 2.9%; >140 mm Hg, 2.6%; P<.001). Women, hypertensives, diabetics, dyslipidemics, and older patients had higher levels of SBP compared with other groups. The SBP of patients who received thrombolytic agents was lower than that of those who did not receive this therapy. Multi-adjusted analysis revealed that a 10-mm Hg increment in SBP was associated with a 27% lower likelihood of death during hospitalization (odds ratio, 0.73; 95% confidence interval, 0.66-0.90).