Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia
BACKGROUND: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP.
METHODS: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016).
RESULTS: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94).
CONCLUSION: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
Journal of clinical medicine - 8(2019), 6 vom: 13. Juni |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ceccato, Adrian [VerfasserIn] |
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| Links: |
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| Themen: |
Host response |
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| Anmerkungen: |
Date Revised 29.09.2020 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3390/jcm8060843 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM298170728 |
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| 520 | |a BACKGROUND: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP | ||
| 520 | |a METHODS: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016) | ||
| 520 | |a RESULTS: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94) | ||
| 520 | |a CONCLUSION: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a host response | |
| 650 | 4 | |a infection | |
| 650 | 4 | |a intensive care unit-acquired pneumonia | |
| 650 | 4 | |a lymphocytes | |
| 650 | 4 | |a mortality | |
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| 700 | 1 | |a Ranzani, Otavio T |e verfasserin |4 aut | |
| 700 | 1 | |a Martin-Fernandez, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Almansa-Mora, Raquel |e verfasserin |4 aut | |
| 700 | 1 | |a Gabarrus, Albert |e verfasserin |4 aut | |
| 700 | 1 | |a Bueno, Leticia |e verfasserin |4 aut | |
| 700 | 1 | |a Cilloniz, Catia |e verfasserin |4 aut | |
| 700 | 1 | |a Liapikou, Adamantia |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrer, Miquel |e verfasserin |4 aut | |
| 700 | 1 | |a Bermejo-Martin, Jesus F |e verfasserin |4 aut | |
| 700 | 1 | |a Torres, Antoni |e verfasserin |4 aut | |
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