非创伤性蛛网膜下腔出血患者的早期淋巴细胞减少症和感染。

Early Lymphopenia and Infections in Nontraumatic Subarachnoid Hemorrhage Patients.

机构信息

Departments of Intensive Care.

Neurosurgery, Erasme Hospital, Free University of Brussles, Brussels, Belgium.

出版信息

J Neurosurg Anesthesiol. 2022 Apr 1;34(2):243-247. doi: 10.1097/ANA.0000000000000744.

DOI:10.1097/ANA.0000000000000744

PMID:33208711

Abstract

INTRODUCTION

Subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. A certain degree of immunodepression has been reported during critical illness, and lymphopenia identified as an independent predictor of poor outcome; no data are available for critically ill SAH patients. We aimed to evaluate the prevalence of lymphopenia among SAH patients and its association with hospital-acquired infection.

METHODS

Retrospective cohort study of adult patients admitted to an intensive care unit with nontraumatic SAH between January 2011 and May 2016. Lymphocyte count was obtained daily for the first 5 days; lymphopenia was defined as lymphocyte count <1000/mm3. The occurrence of infection during the first 21 days after hospital admission, hospital mortality, and unfavorable neurological outcome (Glasgow Outcome Scale score 1 to 3 at 3 mo) were recorded.

RESULTS

Data from 270 patients were analyzed (median age 54 y; male 45%); 121 (45%) patients had lymphopenia and 62 (23%) patients developed infections. Median (25th to 75th percentiles) lymphocyte count at hospital admission was 1280 (890 to 1977)/mm3. Lymphopenia patients had more episodes of infection (38/121, 31% vs. 24/139, 17%; P=0.003) than nonlymphopenia patients, while mortality and unfavorable outcome were similar. Lymphopenia was not independently associated with the development of infection, unfavorable neurological outcome or with mortality.

CONCLUSIONS

Early lymphopenia is common after SAH, but is not significantly associated with the development of infections or with poor outcome.

摘要

简介

蛛网膜下腔出血（SAH）与高发病率和死亡率相关。在危重病期间，已报道存在一定程度的免疫抑制，淋巴细胞减少被确定为不良预后的独立预测因素；但尚无关于重症 SAH 患者的数据。我们旨在评估 SAH 患者中淋巴细胞减少的发生率及其与医院获得性感染的关系。

方法

这是一项回顾性队列研究，纳入 2011 年 1 月至 2016 年 5 月期间入住重症监护病房的非创伤性 SAH 成年患者。在最初的 5 天内每天测量淋巴细胞计数；淋巴细胞减少定义为淋巴细胞计数<1000/mm3。记录住院后前 21 天内感染的发生、住院死亡率和不良神经结局（3 个月时格拉斯哥结局量表评分为 1 至 3 分）。

结果

分析了 270 例患者的数据（中位年龄 54 岁；男性占 45%）；121 例（45%）患者存在淋巴细胞减少，62 例（23%）患者发生感染。入院时的中位数（25 至 75 百分位数）淋巴细胞计数为 1280（890 至 1977）/mm3。淋巴细胞减少患者感染次数更多（38/121，31%比 24/139，17%；P=0.003），而非淋巴细胞减少患者死亡率和不良结局相似。淋巴细胞减少与感染、不良神经结局或死亡率均无独立相关性。