Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admissionReportar como inadecuado




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Annals of Intensive Care

, 7:30

First Online: 17 March 2017Received: 21 July 2016Accepted: 04 February 2017DOI: 10.1186-s13613-017-0242-0

Cite this article as: Adrie, C., Lugosi, M., Sonneville, R. et al. Ann. Intensive Care 2017 7: 30. doi:10.1186-s13613-017-0242-0

Abstract

BackgroundSeverely 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.

MethodsAdults 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 cells-µL; between 1 and 1.5 × 10 cells-µL; between 0.5 and 1 × 10 cells-µL; and below 0.5 × 10 cells-µL.

ResultsA total of 753 patients were included. The median lymphocyte count was 0.8 × 10 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.

ConclusionLymphopenia 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.

KeywordsImmunosuppression Shock ICU Nosocomial Infection Survival Absolute lymphocyte count AbbreviationssHRsub-distribution hazard ratio

ICUintensive care unit

CARScompensatory anti-inflammatory response syndrome, IL-6, interleukin-6

TNF-αtumor nuclear factor

SAPS IISimplified Acute Physiology Score

SOFASequential Organ Failure Assessment

GCSGlasgow Coma Scale

CLLchronic lymphocytic leukemia

HIVinfection with the human immunodeficiency virus

HELICSHospital in Europe Link for Infection Control through Surveillance project

BALbroncho-alveolar lavage

CFUcoloning-forming unit

SIRSsystemic inflammatory response syndrome

IPTWinverse probability of treatment weighted

IL-10interleukin-10

mHLA-DR expressionmonocytes dendritic cell HLA-D expression

Electronic supplementary materialThe online version of this article doi:10.1186-s13613-017-0242-0 contains supplementary material, which is available to authorized users.

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Fuente: https://link.springer.com/







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