Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain.
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Carrer de Villarroel, 170, 08036 Barcelona, Spain.
EBioMedicine. 2017 Oct;24:231-236. doi: 10.1016/j.ebiom.2017.09.023. Epub 2017 Sep 21.
The role of neutrophil and lymphocyte counts in blood as prognosis predictors in Community Acquired Pneumonia (CAP) has not been adequately studied. This was a derivation-validation retrospective study in hospitalized patients with CAP and no prior immunosuppression. We evaluated by multivariate analysis the association between neutrophil and lymphocyte counts and mortality risk at 30-days post hospital admission in these patients. The derivation cohort (n=1550 patients) was recruited in a multi-site study. The validation cohort (n=2846 patients) was recruited in a single-site study. In the derivation cohort, a sub-group of lymphopenic patients, those with <724lymphocytes/mm, showed a 1.93-fold increment in the risk of mortality, independently of the CURB-65 score, critical illness, and receiving an appropriate antibiotic treatment. In the validation cohort, patients with <724lymphocytes/mm showed a 1.86-fold increment in the risk of mortality. The addition of 1 point to the CURB-65 score in those patients with <724lymphocytes/mm improved the performance of this score to identify non-survivors in both cohorts. In conclusion, lymphopenic CAP constitutes a particular immunological phenotype of the disease which is associated with an increased risk of mortality. Assessing lymphocyte counts could contribute to personalized clinical management in CAP.
中性粒细胞和淋巴细胞计数在血液中作为社区获得性肺炎（CAP）预后预测因子的作用尚未得到充分研究。这是一项在没有既往免疫抑制的住院 CAP 患者中进行的推导-验证回顾性研究。我们通过多变量分析评估了这些患者入院后 30 天内中性粒细胞和淋巴细胞计数与死亡率风险之间的关联。推导队列（n=1550 例患者）在一项多中心研究中招募。验证队列（n=2846 例患者）在一项单中心研究中招募。在推导队列中，一组淋巴细胞减少的患者，即淋巴细胞计数<724 个/毫米的患者，其死亡风险增加了 1.93 倍，独立于 CURB-65 评分、危重症和接受适当的抗生素治疗。在验证队列中，淋巴细胞计数<724 个/毫米的患者死亡风险增加了 1.86 倍。在淋巴细胞计数<724 个/毫米的患者中，CURB-65 评分增加 1 分，可提高该评分在两个队列中识别非幸存者的性能。总之，淋巴细胞减少型 CAP 构成了该疾病的一种特殊免疫表型，与死亡率增加相关。评估淋巴细胞计数可能有助于 CAP 的个体化临床管理。
