Author + information
- Abdurrahman Tasal1,
- Ozgur Surgit2,
- Ahmet Bacaksiz1,
- Omer Goktekin1,
- Huseyin Uyarel1,
- Mehmet Ergelen1,
- Ercan Erdogan1,
- Seref Kul1,
- Osman Sonmez1,
- Murat Turfan1,
- Sitki Kucukbuzcu1,
- Mehmet Akif Vatankulu1 and
- Aylin Hatice Yamac1
The aim of the study was to investigate the effect of levosimendan infusion on hematological variables in patients with acute heart failure. Also, predictive value of these variables over in hospital mortality evaluated.
Two hundred and nineteen patients (168 male, 51 female, mean age 63.2±12.7 years) with acute exerbation of advanced heart failure (ejection fraction ≤35%) were included in this study. Levosimendan was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0,1 μg/kg/min for 24 hours. Changes of hematological variables between admission and on third day after levosimendan infusion were evaluated. Categorical variables were expressed as frequencies and percentages. Continuous variables were compared using analysis of variance and Kruskal-Wallis tests for those with normal and skewed distributions, respectively. Chi-square tests were used to compare categorical variables. Univariate and multivariate Cox regression models were used to evaluate the independent association of different hematological variables with in-hospital mortality.
Table 1 demonstrated the baseline demographical and laboratory characteristics of the patients. After levosimendan therapy, significant decrease in WBC and neutrophil counts and increase in lymphocyte count. As a result, neutrophil to lymphocyte ratio (NLR) decreased. Compared to patients that survived, in patients who died during in-hospital stay, these hematological changes not occurred (Table 2). Δ NLR detected as independent predictor of in hospital mortality when other hematological variables associated with mortality analysed in the multivariate logistic regression analysis (R2=0.094, p=0.003).
Our study showed that levosimendan treatment is associated with significant changes in hematological variables in patients with acute exacerbation of advanced heart failure. The difference between baseline and post-treatment NLR is independent predictor of in hospital mortality.
|Age (years)||63.2 ± 12.7|
|EF (%)||26.5 ± 6.4|
|Diabetes mellitus (%)||28.9|
|Ischemic cardiomyopathy (%)||82.7|
|WBC (X1,000/μl)||12.6 ± 4.9|
|Neutrophil (%)||79.3 ± 13.5|
|Lymphocyte (%)||17.1 ± 7.2|
|Neutrophil-to-lymphocyte ratio||6.5 ± 4.7|
Baseline characteristics and hematological variables
|Variables||Group 1||Group 2||p|
|Δ WBC||0.5 ± 2.2||1.1 ± 5.1||0.216|
|Δ Neutrophil||3.3 ± 7.8||- 1.1 ± 7.7||0.001|
|Δ Lymphocyte||-1.4 ± 6.1||1.1 ± 5.4||0.012|
|Δ NLR||1.1 ± 3.7||-2.7 ± 11.6||<0.001|
Comparison of changes in hematological variables of the patients who survived (group 1) and died (group 2)after levosimendan therapy