J Korean Med Sci.  2014 Apr;29(4):519-526. 10.3346/jkms.2014.29.4.519.

White Blood Cell, Hemoglobin and Platelet Distribution Width as Short-Term Prognostic Markers in Patients with Acute Myocardial Infarction

• Bae MH
• Lee JH
• Yang DH
• Park HS
• Cho Y
• Chae SC

• KMID: 1774457
• DOI: http://doi.org/10.3346/jkms.2014.29.4.519

Abstract

The aim of this study was to assess the prognostic value of combined use of white blood cell (WBC), hemoglobin (Hb), and platelet distribution width (PDW) in patients with acute myocardial infarction (AMI). This study included 1,332 consecutive patients with AMI. Patients were categorized into complete blood cell (CBC) group 0 (n=346, 26.0%), 1 (n=622, 46.7%), 2 (n=324, 24.3%), and 3 (n=40, 3.0%) according to the sum of the value defined by the cut-off levels of WBC (1, > or =14.5x10(3)/microL; 0, <14.5x10(3)/microL), Hb (1, <12.7 g/dL; 0, > or =12.7 g/dL), and PDW (1, > or =51.2%; 0: <51.2%). In-hospital death occurred in 59 (4.4%) patients. Patients who died during index hospitalization had higher WBC and PDW and lower Hb. The patients could be stratified for in-hospital mortality according to CBC group; 1.2%, 2.7%, 9.0%, and 22.5% in CBC groups 0, 1, 2, and 3 (P<0.001), respectively. In multivariate logistic regression analysis, CBC group> or =2 (odds ratio, 3.604; 95% confidence interval, 1.040-14.484, P=0.043) was an independent predictor for in-hospital death. The prognostic impact of the combined use of CBC markers remained significant over 12 months. In conclusions, combination of WBC, Hb, and PDW, a cheap and simple hematologic marker, is useful in early risk stratification of patients with AMI.

Keyword

Hemoglobins; Leukocytes; Platelet Distribution Width; Myocardial Infarction

MeSH Terms

Acute Disease
Aged
Biological Markers/blood
Blood Platelets/*cytology/physiology
Female
Hemoglobins/*analysis
Hospital Mortality
Humans
Kaplan-Meier Estimate
Leukocyte Count
Leukocytes/*cytology
Logistic Models
Male
Middle Aged
Myocardial Infarction/*diagnosis/mortality
Odds Ratio
Prognosis
Proportional Hazards Models
ROC Curve
Risk Factors
Biological Markers
Hemoglobins

Figure

• 

  Fig. 1 Histograms of the distribution of baseline white blood cell (10.9±4.1×103/µL, range 2.7-34.8±103/µL), hemoglobin (13.5±1.9 g/dL, range 6.4-18.6 g/dL), and platelet distribution width (52.2±7.4%, range 35.3-82.9%).

• 

  Fig. 2 In-hospital death categorized according to the cut-off levels of white blood cell, hemoglobin, and platelet distribution width. Significant differences in in-hospital death were observed among CBC groups 0 (1.2%), 1 (2.7%), 2 (9.0%), and 3 (22.5%) (P<0.001).

• 

  Fig. 3 Incremental prognostic value of combined use of white blood cell, hemoglobin, and platelet distribution width in the Cox proportional-hazard model. CBC Group ≥2 has incremental prognostic value. Conventional risk factors included age, gender, heart rate, systolic blood pressure, hyperlipidemia, Killip class ≥3, percutaneous coronary intervention at index hospitalization, left anterior descending artery infarction, creatinine ≥2 mg/dL, and sodium.

• 

  Fig. 4 Kaplan-Meier curves for 12-month mortality according to the sum of values defined by the cut-off levels of CBC markers in all patients (A) and in-hospital survivors (B).

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