Raymond D P, Crabtree T D, Pelletier S J, Gleason T G, Banas L E, Patel S, Pruett T L, Sawyer R G
Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, USA.
Am Surg. 2000 Dec;66(12):1124-30; discussion 1130-1.
Historically patients with severely depressed or elevated white blood cell (WBC) counts during infection were felt to have worse outcomes. To test this assumption we prospectively analyzed all infections on the surgical services at the University of Virginia hospital between December 1, 1996 and April 1, 1999. Among 1737 infectious episodes 59 presented with leukopenia (WBC count < or = 3,000 cells/microL) whereas 66 presented with leukemoid responses (WBC count > or = 30,000 cells/microL). Compared with other infected patients leukopenic patients had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (18+/-0.9 vs 12+/-0.2, P < 0.0001) and mortality (23.7% vs 11.4%, P = 0.004). Patients with leukemoid responses also had higher APACHE II scores (21+/-1.0 vs 12+/-0.2, P < 0.0001) and mortality (30.3% vs 11.4%, P < 0.0001). Compared with a control group randomly matched (2:1) by age and APACHE II score, however, there was no significant difference in mortality associated with leukopenia or a leukemoid response. Furthermore logistic regression did not reveal leukopenia or leukemoid responses to be independent predictors of mortality (odds ratio for death with leukopenia = 1.57, 95% confidence interval = 0.63-3.91, P = 0.33; odds ratio for death with leukemoid response = 1.19, 95% confidence interval = 0.70-2.02, P = 0.53). Although very low or very high WBC counts may represent markers of severe illness in infected surgical patients they do not appear to be significant contributors to a worsened outcome.
在历史上，感染期间白细胞（WBC）计数严重降低或升高的患者被认为预后较差。为了验证这一假设，我们对1996年12月1日至1999年4月1日期间弗吉尼亚大学医院外科服务中的所有感染进行了前瞻性分析。在1737次感染发作中，59例出现白细胞减少（WBC计数≤3000个/微升），而66例出现类白血病反应（WBC计数≥30000个/微升）。与其他感染患者相比，白细胞减少的患者急性生理与慢性健康状况评分系统II（APACHE II）得分更高（18±0.9对12±0.2，P<0.0001），死亡率也更高（23.7%对11.4%，P = 0.004）。有类白血病反应的患者APACHE II得分同样更高（21±1.0对12±0.2，P<0.0001），死亡率也更高（30.3%对11.4%，P<0.0001）。然而，与按年龄和APACHE II评分进行随机匹配（2:1）的对照组相比，白细胞减少或类白血病反应相关的死亡率并无显著差异。此外，逻辑回归未显示白细胞减少或类白血病反应是死亡率的独立预测因素（白细胞减少导致死亡的比值比=1.57，95%置信区间=0.63 - 3.91，P = 0.33；类白血病反应导致死亡的比值比=1.19，95%置信区间=0.70 - 2.02，P = 0.53）。虽然极低或极高的WBC计数可能代表感染外科患者病情严重的标志，但它们似乎并非导致预后恶化的重要因素。
