Document Detail

Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction.
MedLine Citation:
PMID:  17173924     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Elevation of total white blood cells (WBC) count is associated with higher mortality in patients with acute coronary syndromes. However, it is unknown which specific subset of leukocytes best correlates with increased risk of adverse outcome.
METHODS AND RESULTS: We prospectively studied the predictive value of WBC subtypes for long-term outcome in 1037 patients with acute myocardial infarction (AMI). Total WBC, neutrophil, monocyte and lymphocyte counts, and high-sensitivity C-reactive protein (CRP) were obtained in each patient. The median duration of follow up was 23 months (range, 6-42 months). Analyzed separately, baseline total WBC (HR 2.2, 95% CI 1.5-3.3; P<0.0001), neutrophil (HR 2.7, 95% CI 1.8-4.1; P<0.0001) and monocyte (HR 1.9, 95% CI 1.3-2.8; P=0.001) counts in the upper quartile, and lymphocyte count in the lower quartile (HR 1.5, 95% CI 1.1-2.3; P=0.03), were all independent predictors of mortality. Comparing nested models, adding other WBC data failed to improve model based on neutrophil count. In contrast, adding neutrophil count to the models based on total WBC (P=0.01), on monocyte count (P<0.0001) or on lymphocyte count (P<0.0001) improved the prediction of the models. Neutrophil count in the upper quartile (>or=9800 microL(-1)) remained a strong independent predictor of mortality after adjustment for left ventricular systolic function and for CRP (HR 2.2, 95% CI 1.6-3.0; P<0.0001).
CONCLUSION: Of all WBC subtypes, elevated neutrophil count best correlates with mortality in patients with AMI. Neutrophil count provides additive prognostic information when combined with CRP.
Robert Dragu; Shafik Khoury; Shafik Huri; Robert Zuckerman; Mahmoud Suleiman; Diab Mutlak; Yoram Agmon; Michael Kapeliovich; Rafael Beyar; Walter Markiewicz; Haim Hammerman; Doron Aronson
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Publication Detail:
Type:  Journal Article     Date:  2006-12-14
Journal Detail:
Title:  Atherosclerosis     Volume:  196     ISSN:  1879-1484     ISO Abbreviation:  Atherosclerosis     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-14     Completed Date:  2008-02-29     Revised Date:  2012-05-01    
Medline Journal Info:
Nlm Unique ID:  0242543     Medline TA:  Atherosclerosis     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  405-12     Citation Subset:  IM    
Department of Cardiology, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Haifa, Israel.
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MeSH Terms
C-Reactive Protein / analysis
Kaplan-Meier Estimate
Leukocyte Count*
Leukocytes, Mononuclear / physiology*
Middle Aged
Myocardial Infarction / blood*,  mortality*
Neutrophils / physiology*
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Reg. No./Substance:
9007-41-4/C-Reactive Protein
Erratum In:
Atherosclerosis. 2012 Apr;221(2):605
Note: Huri, Shafik [corrected to Khoury, Shafik]

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