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. 2017 Aug 14;7(1):85.
doi: 10.1186/s13613-017-0308-z.

Lymphopaenia in cardiac arrest patients

Paola Villois  1 , David Grimaldi  1 , Savino Spadaro  2 , Claudia Righy Shinotsuka  1 , Vito Fontana  1 , Sabino Scolletta  3 , Federico Franchi  3 , Jean-Louis Vincent  1 , Jacques Creteur  1 , Fabio Silvio Taccone  4
Affiliations

Lymphopaenia in cardiac arrest patients

Paola Villois et al. Ann Intensive Care. .

Abstract

Background: A decrease in circulating lymphocytes has been described as a marker of poor prognosis after septic shock; however, scarce data are available after cardiac arrest (CA). The aim of this study was to evaluate the impact of lymphopaenia after successful cardiopulmonary resuscitation.

Methods: This is a retrospective analysis of an institutional database including all adult CA patients admitted to the intensive care unit (ICU) between January 2007 and December 2014 who survived for at least 24 h. Demographic, CA-related data and ICU mortality were recorded as was lymphocyte count on admission and for the first 48 h. A cerebral performance category score of 3-5 at 3 months was considered as an unfavourable neurological outcome.

Results: Data from 377 patients were analysed (median age: 62 [IQRs: 52-75] years). Median time to return of spontaneous circulation (ROSC) was 15 [8-25] min and 232 (62%) had a non-shockable initial rhythm. ICU mortality was 58% (n = 217) and 246 (65%) patients had an unfavourable outcome at 3 months. The median lymphocyte count on admission was 1208 [700-2350]/mm3 and 151 (40%) patients had lymphopaenia (lymphocyte count <1000/mm3). Predictors of lymphopaenia on admission were older age, a shorter time to ROSC, prior use of corticosteroid therapy and high C-reactive protein levels on admission. ICU non-survivors had lower lymphocyte counts on admission than survivors (1100 [613-2317] vs. 1316 [891-2395]/mm3; p = 0.05) as did patients with unfavourable compared to those with favourable neurological outcomes (1100 [600-2013] vs. 1350 [919-2614]/mm3; p = 0.003). However, lymphopaenia on admission was not an independent predictor of poor outcomes in the entire population, but only among OHCA patients.

Conclusions: A low lymphocyte count is common in CA survivors and is associated with poor outcome after OHCA.

Keywords: Cardiac arrest; Lymphopaenia; Outcome; Prognosis.

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Figures

Fig. 1
Fig. 1
Differences in lymphocyte counts on admission among survivors versus non-survivors; patients with favourable (FO) versus unfavourable neurological outcome (UO); patients receiving immunosuppressive agents (IS+) versus others (IS−); patients with in-hospital (IHCA) versus out-of-hospital cardiac arrest (OHCA); patients with shockable rhythms (VF/VT) versus others (no VF/VT); patients who developed infection versus those without infection. Data are presented as median and 25th (lower limit) and 75th percentiles (upper limit). *p < 0.05 for lymphocyte count
Fig. 2
Fig. 2
Proportion of patients on immunosuppressive therapy, developing infections, non-survivors and with favourable neurological outcome (FO) according to the different groups of lymphocyte levels over the first 48 h after arrest: “group 1” included patients with persistent lymphopaenia throughout the 48 h; “group 2” included patients with lymphopaenia on admission but with normal lymphocyte counts at 48 h; “group 3” included those who had normal lymphocyte counts throughout the 48-h study period; and “group 4” those with normal lymphocyte counts on admission but who had developed lymphopaenia by 48 h
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