Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Oct:24:231-236.
doi: 10.1016/j.ebiom.2017.09.023. Epub 2017 Sep 21.

Lymphopenic Community Acquired Pneumonia (L-CAP), an Immunological Phenotype Associated with Higher Risk of Mortality

Jesus F Bermejo-Martin  1 , Catia Cilloniz  2 , Raul Mendez  3 , Raquel Almansa  1 , Albert Gabarrus  2 , Adrian Ceccato  2 , Antoni Torres  4 , Rosario Menendez  5 ; NEUMONAC group
Affiliations
Multicenter Study

Lymphopenic Community Acquired Pneumonia (L-CAP), an Immunological Phenotype Associated with Higher Risk of Mortality

Jesus F Bermejo-Martin et al. EBioMedicine. 2017 Oct.

Abstract

The role of neutrophil and lymphocyte counts in blood as prognosis predictors in Community Acquired Pneumonia (CAP) has not been adequately studied. This was a derivation-validation retrospective study in hospitalized patients with CAP and no prior immunosuppression. We evaluated by multivariate analysis the association between neutrophil and lymphocyte counts and mortality risk at 30-days post hospital admission in these patients. The derivation cohort (n=1550 patients) was recruited in a multi-site study. The validation cohort (n=2846 patients) was recruited in a single-site study. In the derivation cohort, a sub-group of lymphopenic patients, those with <724lymphocytes/mm3, showed a 1.93-fold increment in the risk of mortality, independently of the CURB-65 score, critical illness, and receiving an appropriate antibiotic treatment. In the validation cohort, patients with <724lymphocytes/mm3 showed a 1.86-fold increment in the risk of mortality. The addition of 1 point to the CURB-65 score in those patients with <724lymphocytes/mm3 improved the performance of this score to identify non-survivors in both cohorts. In conclusion, lymphopenic CAP constitutes a particular immunological phenotype of the disease which is associated with an increased risk of mortality. Assessing lymphocyte counts could contribute to personalized clinical management in CAP.

Keywords: Acquired; Community; Lymphocyte; Mortality; Pneumonia.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
AUROC Analysis of Lymphocyte Concentrations in Blood to Predict Survival at 30-Days Post-Admission.The OOP was identified in the derivation cohort as < 724 lymphocytes/mm3. Sensitivity/Specificity for the OOP were 57%/68% in the derivation cohort and 67%/50% in the validation cohort.
Fig. 2
Fig. 2
Comparison of AUCs of CURB-65 and CURB-65L to Predict 30-Day Mortality: One extra point was added to the CURB-65 score of those patients with lymphocyte counts below 724 cells/mm3 to build the CURB-65L.
See this image and copyright information in PMC

Comment in

References

    1. Aliberti S., Brambilla A.M., Chalmers J.D., Cilloniz C., Ramirez J., Bignamini A., Prina E., Polverino E., Tarsia P., Pesci A., Torres A., Blasi F., Cosentini R. Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis. Respir. Res. 2014;15:27. - PMC - PubMed
    1. Almansa R., Ortega A., Ávila-Alonso A., Heredia-Rodríguez M., Martín S., Benavides D., Martín-Fernandez M., Rico L., Aldecoa C., Rico J., López de Cenarruzabeitia I., Beltrán de Heredia J., Gomez-Sanchez E., Aragón M., Andrés C., Calvo D., Andaluz-Ojeda D., Liu P., Blanco-Antona F., Blanco L., Gómez-Herreras J.I., Tamayo E., Bermejo-Martin J.F. Quantification of immune dysregulation by next-generation polymerase chain reaction to improve sepsis diagnosis in surgical patients. Ann. Surg. 2017 - PubMed
    1. Andrijevic I., Matijasevic J., Andrijevic L., Kovacevic T., Zaric B. Interleukin-6 and procalcitonin as biomarkers in mortality prediction of hospitalized patients with community acquired pneumonia. Ann. Thorac. Med. 2014;9:162–167. - PMC - PubMed
    1. ARDS Definition Task Force, Ranieri V.M., Rubenfeld G.D., Thompson B.T., Ferguson N.D., Caldwell E., Fan E., Camporota L., Slutsky A.S. Acute respiratory distress syndrome: the berlin definition. JAMA. 2012;307:2526–2533. - PubMed
    1. Bellomo R., Ronco C., Kellum J.A., Mehta R.L., Palevsky P., Acute Dialysis Quality Initiative workgroup Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit. Care Lond. Engl. 2004;8:R204–212. - PMC - PubMed

Publication types

MeSH terms