Background
Methods
Study design and patients
Baseline characteristics
Statistics
Results
Study participants and baseline characteristics
Characteristic | Leukocyte count | ||||
---|---|---|---|---|---|
≦ 5.5 n = 753 | 5.5–6.7 n = 707 | 6.7–8.0 n = 720 | > 8.0 n = 718 | p-value | |
Age, mean ± SD, years | 69 ± 9.2 | 69 ± 9.7 | 69 ± 10 | 69 ± 9 | 0.867 |
Male (%) | 289 (38) | 304 (43) | 362 (50) | 372 (52) | 0.000 |
Race | 0.620 | ||||
White (%) | 671 (89) | 629 (89) | 641 (89) | 629 (88) | |
Black (%) | 69 (9) | 58 (8) | 63 (9) | 66 (9) | |
Other (%) | 13 (2) | 20 (2) | 16 (2) | 23 (3) | |
Smoker (%) | 237 (32) | 241 (34) | 267 (37) | 306 (43) | 0.001 |
Hypertension (%) | 685 (91) | 645 (91) | 673 (94) | 673 (94) | 0.077 |
Dyslipidemia (%) | 431 (57) | 406 (57) | 423 (59) | 483 (67) | 0.000 |
Previous myocardial infarction (%) | 143 (19) | 154 (22) | 173 (24) | 192 (27) | 0.004 |
Prior heart failure hospitalization (%) | 562 (75) | 511 (72) | 520 (72) | 504 (70) | 0.304 |
Angina pectoris (%) | 340 (45) | 347 (49) | 345 (48) | 311 (43) | 0.112 |
PCI (%) | 89 (12) | 87 (12) | 97 (14) | 132 (19) | 0.000 |
CABG (%) | 75 (10) | 80 (11) | 85 (12) | 113 (16) | 0.006 |
Diabetes mellitus (%) | 198 (26) | 198 (28) | 244 (34) | 318 (44) | 0.000 |
Atrial fibrillation (%) | 262 (35) | 218 (31) | 239 (33) | 280 (39) | 0.011 |
COPD (%) | 58 (8) | 67 (10) | 89 (12) | 124 (17) | 0.000 |
Asthma (%) | 36 (5) | 56 (8) | 43 (6) | 61 (9) | 0.016 |
Stroke (%) | 56 (7) | 43 (6) | 59 (8) | 68 (10) | 0.112 |
Peripheral arterial disease (%) | 49 (7) | 55 (8) | 66 (9) | 89 (12) | 0.000 |
Thyroid disease (%) | 128 (17) | 105 (15) | 104 (15) | 143 (20) | 0.021 |
Pacemaker implanted (%) | 64 (9) | 50 (7) | 56 (8) | 61 (9) | 0.713 |
ICD (%) | 10 (1.3) | 8 (1.1) | 8 (1.1) | 12 (1.7) | 0.773 |
HR (b.p.m.) | 69 ± 10.1 | 68 ± 9.9 | 68 ± 11.1 | 70 ± 11.3 | 0.078 |
Systolic blood pressure, mean ± SD, mmHg | 129 ± 12.6 | 130 ± 13.9 | 130 ± 14.6 | 129 ± 14.9 | 0.110 |
Diastolic blood pressure | 76 ± 10.4 | 77 ± 10.6 | 76 ± 10.8 | 74 ± 11.1 | 0.000 |
Body mass index, mean ± SD, kg/m2 | 31 ± 6.6 | 32 ± 6.5 | 32 ± 7.1 | 34 ± 7.9 | 0.000 |
eGFR (mL/min) | 67 ± 18.2 | 69 ± 22.5 | 68 ± 19.8 | 65 ± 20.1 | 0.002 |
BUN (mg/dL) | 16.5 (6.8,22.1) | 16.2 (5.0,22.4) | 16.5 (5.6,23.0) | 17.6 (8.1,26.0) | 0.004 |
Hematocrit (%) | 39 ± 5.0 | 40 ± 4.8 | 40 ± 5.4 | 41 ± 5.7 | 0.000 |
Hemoglobin (g/dL) | 12.9 (12.0,14.0) | 13.2 (12.2,14.3) | 13.4 (12.3,14.5) | 13.5 (12.2,14.8) | 0.000 |
Platelet (k/uL) | 207 (173,243) | 220 (188,254) | 223 (193,264) | 245 (208,294) | 0.000 |
Albumin (g/dL) | 3.9 ± 2.5 | 3.8 ± 2.7 | 3.7 ± 2.5 | 3.7 ± 2.8 | 0.000 |
logBNP | 2.6 ± 0.5 | 2.6 ± 0.5 | 2.6 ± 0.5 | 2.6 ± 0.5 | 0.627 |
LVEF (%) | 59 ± 6.5 | 59 ± 6.9 | 59 ± 6.0 | 59 ± 6.7 | 0.076 |
New York Heart Association class III-IV (%) | 514 (68) | 509 (72) | 501 (70) | 428 (60) | 0.000 |
Aspirin use (%) | 453 (60) | 458 (65) | 475 (66) | 458 (64) | 0.110 |
b-blockers (%) | 573 (76) | 555 (79) | 565 (79) | 551 (78) | 0.599 |
ACEi (%) | 504 (66) | 455 (64) | 455 (63) | 438 (61) | 0.120 |
ARB (%) | 107 (14) | 113 (16) | 109 (15) | 132 (18) | 0.155 |
Statins (%) | 334 (44) | 332 (47) | 362 (50) | 426 (59) | 0.000 |
Calcium channel blockers (%) | 276 (37) | 292 (41) | 272 (38) | 281 (39) | 0.300 |
Spironolactone (%) | 361 (48) | 370 (52) | 346 (48) | 378 (53) | 0.118 |
Loop diuretic (%) | 326 (43) | 329 (47) | 349 (49) | 458 (64) | 0.000 |
Thiazide diuretic (%) | 322 (43) | 278 (39) | 286 (40) | 216 (30) | 0.000 |
Leukocyte count on admission and long-term clinicaloutcomes
All-cause mortality | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
HR | 95%CI | p-value | HR | 95%CI | p-value | |
Age | 1.054 | 1.043–1.065 | 0.000 | 1.046 | 1.033–1.059 | 0.000 |
Sex | 0.67 | 0.554–0.810 | 0.000 | 1.698 | 1.368–2.106 | 0.000 |
Race | 1.528 | 1.251–1.867 | 0.000 | 0.037 | ||
0.531 | 0.326–0.865 | 0.011 | ||||
0.591 | 0.332–1.049 | 0.073 | ||||
BMI | 1.007 | 0.993–1.021 | 0.330 | – | – | – |
Smoker | 1.170 | 1.037–1.320 | 0.011 | – | – | – |
LVEF | 0.998 | 0.984–1.013 | 0.820 | – | – | – |
Angina pectoris | 0.613 | 0.504–0.745 | 0.000 | 0.815 | 0.653–1.017 | 0.071 |
Prior heart failure hospitalization | 0.810 | 0.657–0.997 | 0.047 | 1.124 | 0.901–1.403 | 0.301 |
Previous myocardial infarction | 1.266 | 1.026–1.563 | 0.028 | 0.777 | 0.603–1.002 | 0.052 |
Stroke | 1.558 | 1.151–2.110 | 0.004 | 0.940 | 0.686–1.289 | 0.702 |
CABG | 1.655 | 1.293–2.118 | 0.000 | 1.066 | 0.800–1.422 | 0.661 |
PCI | 1.483 | 1.161–1.893 | 0.002 | 1.061 | 0.803–1.403 | 0.677 |
COPD | 1.629 | 1.257–2.111 | 0.000 | 0.936 | 0.713–1.228 | 0.634 |
Asthma | 1.601 | 1.152–2.226 | 0.005 | 0.812 | 0.574–1.148 | 0.239 |
Hypertension | 0.815 | 0.586–1.133 | 0.223 | – | – | – |
Peripheral arterial disease | 2.154 | 1.669–2.779 | 0.000 | 0.615 | 0.468–0.809 | 0.001 |
Dyslipidemia | 1.271 | 1.043–1.550 | 0.018 | 1.105 | 0.857–1.426 | 0.441 |
ICD | 1.605 | 0.797–3.230 | 0.185 | – | – | – |
Pacemaker | 1.983 | 1.500–2.621 | 0.000 | 0.978 | 0.724–1.320 | 0.884 |
Atrial fibrillation | 1.530 | 1.264–1.851 | 0.000 | 1.016 | 0.821–1.258 | 0.884 |
Thyroid disease | 1.219 | 0.957–1.553 | 0.108 | – | – | – |
Diabetes mellitus | 0.595 | 0.491–0.721 | 0.000 | 0.857 | 0.685–1.071 | 0.175 |
Heart rate | 1.017 | 1.008–1.026 | 0.000 | 1.021 | 1.012–1.031 | 0.000 |
Systolic blood pressure | 0.981 | 0.974–0.988 | 0.000 | 0.992 | 0.984–1.000 | 0.050 |
Diastolic blood pressure | 0.959 | 0.951–0.967 | 0.000 | 0.994 | 0.982–1.006 | 0.300 |
Fasting glucose | 1.002 | 0.998–1.005 | 0.343 | – | – | – |
New York Heart Association class III-IV | 1.723 | 1.423–2.086 | 0.000 | 0.806 | 0.658–0.988 | 0.038 |
eGFR | 0.979 | 0.973–0.984 | 0.000 | 0.994 | 0.988–1.000 | 0.055 |
Leukocyte group | 1.249 | 1.146–1.361 | 0.000 | 0.000 | ||
1 | 1.439 | 1.060–1.953 | 0.020 | |||
2 | Reference | |||||
3 | 1.510 | 1.113–2.050 | 0.008 | |||
4 | 1.901 | 1.424–2.539 | 0.000 | |||
Hemoglobin | 0.833 | 0.786–0.882 | 0.000 | 0.898 | 0.843–0.958 | 0.001 |
BUN | 1.030 | 1.025–1.036 | 0.000 | 1.009 | 1.001–1.017 | 0.023 |
Albumin | 0.983 | 0.945–1.023 | 0.411 | – | – | – |
Aspirin | 1.301 | 1.074–1.576 | 0.007 | 1.089 | 0.884–1.341 | 0.424 |
b-blockers | 1.16 | 0.915–1.471 | 0.220 | – | – | – |
ACEi | 1.355 | 1.116–1.643 | 0.002 | 0.945 | 0.770–1.160 | 0.591 |
ARB | 0.862 | 0.670–1.109 | 0.248 | – | – | – |
Statin | 0.726 | 0.599–0.878 | 0.001 | 1.072 | 0.837–1.372 | 0.581 |
Loop diuretic | 0.304 | 0.245–0.377 | 0.000 | 0.553 | 0.423–0.724 | 0.000 |
Thiazide Diuretic | 0.494 | 0.398–0.612 | 0.000 | 1.080 | 0.840–1.388 | 0.548 |
Spironolactone | 1.029 | 0.851–1.243 | 0.769 | – | – | – |
All-cause mortality | Male | Female | ||||
---|---|---|---|---|---|---|
HR | 95%CI | p-value | HR | 95% CI | p-value | |
Age | 1.047 | 1.029–1.066 | 0.000 | 1.038 | 1.019–1.057 | 0.000 |
Race | 0.473 | 0.007 | ||||
0.684 | 0.328–1.424 | 0.310 | 0.344 | 0.175–0.676 | 0.002 | |
0.837 | 0.354–1.982 | 0.687 | 0.319 | 0.143–0.709 | 0.005 | |
Smoker | 0.858 | 0.743–0.991 | 0.037 | 0.864 | 0.697–1.070 | 0.180 |
Angina pectoris | 0.967 | 0.715–1.309 | 0.830 | 0.692 | 0.493–0.970 | 0.033 |
Prior heart failure hospitalization | 1.269 | 0.933–1.727 | 0.130 | 0.928 | 0.665–1.296 | 0.661 |
Previous myocardial infarction | 0.742 | 0.536–1.025 | 0.071 | 0.893 | 0.583–1.366 | 0.602 |
Stroke | 0.851 | 0.551–1.315 | 0.468 | 0.993 | 0.619–1.593 | 0.978 |
CABG | 1.109 | 0.772–1.592 | 0.576 | 0.953 | 0.580–1.566 | 0.850 |
PCI | 1.168 | 0.805–1.693 | 0.414 | 0.927 | 0.594–1.447 | 0.739 |
COPD | 1.118 | 0.780–1.602 | 0.544 | 0.687 | 0.445–1.061 | 0.091 |
Asthma | 0.602 | 0.356–1.018 | 0.058 | 1.070 | 0.660–1.736 | 0.783 |
Peripheral arterial disease | 0.562 | 0.394–0.801 | 0.001 | 0.657 | 0.420–1.029 | 0.067 |
Dyslipidemia | 1.158 | 0.816–1.643 | 0.412 | 1.121 | 0.770–1.634 | 0.550 |
Pacemaker | 0.863 | 0.574–1.298 | 0.479 | 1.116 | 0.697–1.787 | 0.647 |
Atrial fibrillation | 1.139 | 0.852–1.521 | 0.380 | 0.860 | 0.622–1.189 | 0.360 |
Diabetes mellitus | 0.986 | 0.729–1.334 | 0.926 | 0.737 | 0.527–1.032 | 0.075 |
Heart rate | 1.019 | 1.006–1.032 | 0.005 | 1.028 | 1.014–1.042 | 0.000 |
Systolic blood pressure | 0.993 | 0.982–1.005 | 0.244 | 0.994 | 0.982–1.005 | 0.286 |
Diastolic blood pressure | 0.990 | 0.974–1.007 | 0.251 | 0.992 | 0.975–1.010 | 0.332 |
New York Heart Association class III-IV | 0.805 | 0.604–1.072 | 0.138 | 0.756 | 0.557–1.026 | 0.072 |
eGFR | 0.995 | 0.986–1.003 | 0.211 | 0.993 | 0.984–1.002 | 0.143 |
Leukocyte group | 0.088 | 0.002 | ||||
1 | 1.134 | 0.745–1.726 | 0.557 | 1.907 | 1.188–3.059 | 0.007 |
2 | reference | |||||
3 | 1.150 | 0.768–1.721 | 0.498 | 2.088 | 1.291–3.375 | 0.003 |
4 | 1.571 | 1.071–2.303 | 0.021 | 2.445 | 1.543–3.875 | 0.000 |
Hemoglobin | 0.889 | 0.816–0.968 | 0.007 | 0.910 | 0.822–1.006 | 0.066 |
BUN | 1.011 | 1.001–1.021 | 0.032 | 1.005 | 0.993–1.018 | 0.419 |
Aspirin | 1.354 | 1.021–1.795 | 0.035 | 0.838 | 0.609–1.153 | 0.277 |
ACEi | 1.007 | 0.759–1.335 | 0.963 | 0.884 | 0.650–1.202 | 0.432 |
Statin | 1.006 | 0.713–1.420 | 0.972 | 1.142 | 0.790–1.651 | 0.479 |
Loop Diuretic | 0.627 | 0.441–0.892 | 0.010 | 0.467 | 0.308–0.707 | 0.000 |
Thiazide Diuretic | 0.925 | 0.666–1.285 | 0.642 | 1.303 | 0.880–1.930 | 0.186 |