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. 2019 May 27;8(5):754.
doi: 10.3390/jcm8050754.

Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock

Estel Güell  1   2   3 , Marta Martín-Fernandez  4 , Mari C De la Torre  5   6 , Elisabet Palomera  7   8 , Mateu Serra  9 , Rafael Martinez  10 , Manel Solsona  11 , Gloria Miró  12 , Jordi Vallès  13 , Samuel Fernández  14 , Edgar Cortés  15 , Vanessa Ferrer  16 , Marc Morales  17 , Juan C Yébenes  18 , Jordi Almirall  19   20   21 , Jesús F Bermejo-Martin  22   23
Affiliations

Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock

Estel Güell et al. J Clin Med. .

Abstract

Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed.

Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome.

Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality.

Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.

Keywords: community-acquired pneumonia; leukocyte subclasses counts; lymphocytes; mortality risk; neutrophils.

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Conflict of interest statement

All authors declare that they have no conflicts of interest regarding this submission.

Figures

Figure 1
Figure 1
AUROC analysis for ICU mortality in sCAP patients with septic shock.
Figure 2
Figure 2
AUROC analysis for ICU mortality in sCAP patients with no septic shock.
See this image and copyright information in PMC

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