Ortega-Loubon Christian, Cano-Hernández Beatriz, Poves-Alvarez Rodrigo, Muñoz-Moreno María Fe, Román-García Patricia, Balbás-Alvarez Sara, de la Varga-Martínez Olga, Gómez-Sánchez Esther, Gómez-Pesquera Estefanía, Lorenzo-López Mario, Tamayo Eduardo, Heredia-Rodríguez María
Department of Cardiac Surgery, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
J Clin Med. 2019 Sep 20;8(10):1512. doi: 10.3390/jcm8101512.
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome ( < 0.001). Lymphocyte counts <0.703 × 10 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700-0.867, < 0.001), and lymphocyte count <1.272 × 10 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716-0.866, < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39-10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24-8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.
淋巴细胞减少与脓毒症患者死亡率增加有关。尽管如此，淋巴细胞计数对念珠菌血症死亡率和预后的影响尚未得到探讨。我们进行了一项回顾性研究，纳入了2007年至2016年期间所有收治的念珠菌血症患者。我们检测了念珠菌血症诊断后前5天的淋巴细胞计数。进行多变量逻辑回归分析以确定淋巴细胞计数与死亡率之间的关系。采用分类与回归树分析来确定与念珠菌血症相关死亡率的淋巴细胞计数最佳临界值。在296例念珠菌血症病例中，115例死亡（30天死亡率为39.8%）。淋巴细胞计数低与死亡率及不良预后相关（P<0.001）。诊断时淋巴细胞计数<0.703×10⁹/L（曲线下面积（AUC）-ROC，0.783±0.042；95%置信区间（CI），0.700-0.867，P<0.001），以及5天后淋巴细胞计数<1.272×10⁹/L（AUC-ROC，0.791±0.038；95%CI，0.716-0.866，P<0.001），在诊断时使死亡几率增加5倍（比值比（OR），5.01；95%CI，2.39-10.93），到第5天时增加3倍（OR，3.27；95%CI，1.24-8.62）。淋巴细胞计数低是念珠菌血症患者死亡率的独立预测因素，可能作为预测念珠菌血症相关死亡率和不良预后的生物标志物。
