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. 2019 Jun 13;8(6):843.
doi: 10.3390/jcm8060843.

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Adrian Ceccato  1 , Meropi Panagiotarakou  2 , Otavio T Ranzani  3   4 , Marta Martin-Fernandez  5 , Raquel Almansa-Mora  6 , Albert Gabarrus  7 , Leticia Bueno  8 , Catia Cilloniz  9 , Adamantia Liapikou  10 , Miquel Ferrer  11 , Jesus F Bermejo-Martin  12 , Antoni Torres  13
Affiliations

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Adrian Ceccato et al. J Clin Med. .

Abstract

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.

Keywords: host response; infection; intensive care unit-acquired pneumonia; lymphocytes; mortality.

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Conflict of interest statement

The authors have no conflicts of interest to declare. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Figures

Figure 1
Figure 1
Flowchart. ICU-AP: intensive care unit-acquired pneumonia, VAP: ventilator-associated pneumonia.
Figure 2
Figure 2
Kaplan–Meier survival curves for 90-day mortality in ICU-AP patients in relation to their lymphocyte counts at diagnosis.
Figure 3
Figure 3
(A) Crude and (B) adjusted effect of lymphocytes on 90-day mortality. The curves were estimated in Cox proportional hazards models using restricted cubic splines with four degrees of freedom (df); 95% CI in shaded area, Rug density of lymphocytes distribution at the bottom. Adjusted for age, liver, cardiovascular and respiratory chronic diseases, systemic steroids at ICU-AP diagnosis, and SOFA at ICU-AP diagnosis; p for nonlinearity, p-value crude: < 0.001, p-value adjusted: 0.0315.
See this image and copyright information in PMC

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