Title |
Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission
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Published in |
Annals of Intensive Care, March 2017
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DOI | 10.1186/s13613-017-0242-0 |
Pubmed ID | |
Authors |
Christophe Adrie, Maxime Lugosi, Romain Sonneville, Bertrand Souweine, Stéphane Ruckly, Jean-Charles Cartier, Maité Garrouste-Orgeas, Carole Schwebel, Jean-François Timsit, On behalf of the OUTCOMEREA study group |
Abstract |
Severely ill patients might develop an alteration of their immune system called post-aggressive immunosuppression. We sought to assess the risk of ICU-acquired infection and of mortality according to the absolute lymphocyte count at ICU admission and its changes over 3 days. Adults in ICU for at least 3 days with a shock or persistent low blood pressure were extracted from a French ICU database and included. We evaluated the impact of the absolute lymphocyte count at baseline and its change at day 3 on the incidence of ICU-acquired infection and on the 28-day mortality rate. We categorized lymphocytes in 4 groups: above 1.5 × 10(3) cells/µL; between 1 and 1.5 × 10(3) cells/µL; between 0.5 and 1 × 10(3) cells/µL; and below 0.5 × 10(3) cells/µL. A total of 753 patients were included. The median lymphocyte count was 0.8 × 10(3) cells/µL [0.51-1.29]. A total of 174 (23%) patients developed infections; the 28-day mortality rate was 21% (161/753). Lymphopenia at admission was associated with ICU-acquired infection (p < 0.001) but not with 28-day mortality. Independently of baseline lymphocyte count, the absence of lymphocyte count increase at day 3 was associated with ICU-acquired infection (sub-distribution hazard ratio sHR: 1.37 [1.12-1.67], p = 0.002) and with 28-day mortality (sHR: 1.67 [1.37-2.03], p < 0.0001). Lymphopenia at ICU admission and its persistence at day 3 were associated with an increased risk of ICU-acquired infection, while only persisting lymphopenia predicted increased 28-day mortality. The lymphocyte count at ICU admission and at day 3 could be used as a simple and reproductive marker of post-aggressive immunosuppression. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 8 | 13% |
France | 4 | 6% |
Canada | 4 | 6% |
United Kingdom | 3 | 5% |
Germany | 3 | 5% |
Spain | 3 | 5% |
Portugal | 2 | 3% |
Australia | 2 | 3% |
Austria | 1 | 2% |
Other | 3 | 5% |
Unknown | 30 | 48% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 48 | 76% |
Practitioners (doctors, other healthcare professionals) | 8 | 13% |
Scientists | 6 | 10% |
Science communicators (journalists, bloggers, editors) | 1 | 2% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 58 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 8 | 14% |
Student > Ph. D. Student | 7 | 12% |
Researcher | 6 | 10% |
Other | 3 | 5% |
Student > Master | 3 | 5% |
Other | 10 | 17% |
Unknown | 21 | 36% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 19 | 33% |
Immunology and Microbiology | 6 | 10% |
Biochemistry, Genetics and Molecular Biology | 3 | 5% |
Nursing and Health Professions | 2 | 3% |
Computer Science | 1 | 2% |
Other | 2 | 3% |
Unknown | 25 | 43% |