• Mehmet Ali Cikrikcioglu, Pinar Soysal, Digdem Dikerdem, Mustafa Cakirca, Rumeyza Kazancioglu, Servet Yolbas, Hafize Erkal, Mehmet Hursitoglu, Tulin Kurt Karakose, Muharrem Kiskac, Mehmet Akkaya, Mehmet Zorlu, Muhammed Emin Akkoyunlu, and Tufan Tukek.
• Internal Medicine Clinic, Bezmialem Vakif University, Fatih, Istanbul, Turkey. malicikrikcioglu@yahoo.com
• Eur J Emerg Med. 2012 Aug 1;19(4):257-63.

ObjectiveIn acute heart failure (AHF), hemoglobin, red cell distribution width, mean platelet volume, leukocytes, and relative lymphocyte count have been associated with mortality. It is not known whether absolute blood neutrophil, eosinophil, and monocyte counts are mortality predictors.MethodsOne hundred and seventy-six patients hospitalized due to AHF were enrolled. Treatment modalities and comorbidities influencing leukocyte counts were excluded. Hemogram, pro-brain natriuretic peptide, D-dimer, biochemistry, thyroid hormones, sensitive C-reactive protein, and echocardiography were obtained. Cardiovascular deaths during the first year after hospitalization were determined.ResultsLeukocyte and absolute neutrophil count were significantly higher and absolute lymphocyte count and absolute eosinophil count (AEC) were significantly lower in deceased patients than patients who survived. Groups were similar in terms of monocyte counts. BMI albumin, estimated glomerular filtration rate, free T3, ejection fraction were significantly lower, and ferritin, uric acid, D-dimer, pro-brain natriuretic peptide were significantly higher in deceased patients. Mitral regurgitation, hypotension, hyponatremia, and acute renal failure were also significantly more frequent among the deceased group. Binary logistic regression analysis employing significant variables showed that lower BMI, lower ejection fraction, hyponatremia, lower free T3, and lower AEC were independent predictors of death and as a whole were responsible from 81.8% of cardiovascular deaths. Death rate among patients with an AEC of 0.02 n/l×10 or less was 4.4-fold higher than patients with an AEC of more than 0.02 n/l×10.ConclusionAEC of AHF patients measured at admission was found to be a stronger predictor of mortality than all other hemogram parameters and this is consistent with the increased sympatho-adrenal activity theory.

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