Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission - 08/01/26
, Maxime Lugosi 3 , Romain Sonneville 4 , Bertrand Souweine 5 , Stéphane Ruckly 6 , Jean-Charles Cartier 3 , Maité Garrouste-Orgeas 7 , Carole Schwebel 3 , Jean-François Timsit 4, 6 On behalf of the OUTCOMEREA study group
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Abstract |
Background |
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.
Methods |
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.
Results |
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).
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Immunosuppression, Shock, ICU, Nosocomial, Infection, Survival, Absolute lymphocyte count
Plan
Vol 7 - N° 1
Article 30- 2017 Retour au numéro
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