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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission
Annals of Intensive Care, Volume 7, No. 1, Article 30, Year 2017
Notification
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Description
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 × 103 cells/µL; between 1 and 1.5 × 103 cells/µL; between 0.5 and 1 × 103 cells/µL; and below 0.5 × 103 cells/µL. Results: A total of 753 patients were included. The median lymphocyte count was 0.8 × 103 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. © 2017, The Author(s).
Authors & Co-Authors
Adrie, Christophe
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
France, Saint-denis
Hôpital Delafontaine
Souweine, Bertrand
France, Clermont-ferrand
Hopital Gabriel Montpied
Ruckly, Stéphane
France, Paris
Inserm
Garrouste-Orgeas, Maïté
France, Paris
Groupe Hospitalier Paris Saint-joseph
Schwebel, Carole
France, La Tronche
Hôpital A. Michallon Chu Grenoble
Timsit, Jéan-François Franc¸ois
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
France, Paris
Inserm
Azoulay, Elie
Unknown Affiliation
Cohen, Yves
Unknown Affiliation
Soufir, Lilia
Unknown Affiliation
Zahar, Jean Ralph
Unknown Affiliation
Darmon, Michaël
Unknown Affiliation
Alberti, Corinne
Unknown Affiliation
Clec'H, Christophe
Unknown Affiliation
Français, Adrien
Unknown Affiliation
Vésin, Aure´lien
Unknown Affiliation
Lecorre, Frederik
Unknown Affiliation
Nakache, Didier
Unknown Affiliation
Allaouchiche, Bernard
Unknown Affiliation
Bornstain, Caroline
Unknown Affiliation
Bouadma, Lila
Unknown Affiliation
Boyer, Alexandre
Unknown Affiliation
Cheval, Christine
Unknown Affiliation
Colin, Jean Pierre
Unknown Affiliation
Dumenil, Anne Sylvie
Unknown Affiliation
Descorps-Déclère, Adrien
Unknown Affiliation
Fosse, Jean Philippe
Unknown Affiliation
Jamali, Samir
Unknown Affiliation
Kallel, Hatem
Unknown Affiliation
Laplace, Christian
Unknown Affiliation
Lautrette, Alexandre
Unknown Affiliation
Lazard, Thierry
Unknown Affiliation
Montésino, Laurent
Unknown Affiliation
Mourvillier, Bruno H.
Unknown Affiliation
Misset, Benoıˆt Y.
Unknown Affiliation
Moreau, Delphine
Unknown Affiliation
Pigné, Etienne
Unknown Affiliation
Troché, Gilles
Unknown Affiliation
Thuong, Marie
Unknown Affiliation
Thierry, Guillaume L.
Unknown Affiliation
Tournegros, Caroline
Unknown Affiliation
Ferrand, Loïc
Unknown Affiliation
Mellouk, Kaouttar Aid
Unknown Affiliation
Statistics
Citations: 59
Authors: 42
Affiliations: 6
Identifiers
Doi:
10.1186/s13613-017-0242-0
ISSN:
21105820
Research Areas
Environmental
Noncommunicable Diseases
Sexual And Reproductive Health
Study Design
Cohort Study