Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Carver College of Medicine, University of Iowa, Iowa City, Iowa.
J Surg Res. 2022 Feb;270:293-299. doi: 10.1016/j.jss.2021.09.013. Epub 2021 Oct 28.
Lymphopenia contributes to the immune suppression observed in critical illness. However, its role in the immunologic response to trauma remains unclear. Herein, we assessed whether admission lymphopenia is associated with poor outcomes in patients with blunt chest wall trauma (BCWT).
All adult patients with a Chest Abbreviated Injury Score (CAIS) ≥2 admitted to our Level I Trauma center between May 2009 and December 2018 were identified in our institution Trauma Registry. Patients with absolute lymphocyte counts (ALC) collected within 24 H of admission were included. Patients who died within 24 H of admission, had bowel perforation on admission, penetrating trauma, and burns were excluded. Demographics, injury characteristics, comorbidities, ALC, complications, and outcomes were collected. Lymphopenia was defined as an ALC ≤1000/µL. Association between lymphopenia and clinical outcomes of BCWT was assessed using multivariate analyses. P < 0.05 was considered significant.
A total of 1394 patients were included; 69.7% were male; 44.3% were lymphopenic. On univariate analysis, lymphopenia was associated with longer in-hospital stay (11.6±10.2 versus 10.1±11.4, P = 0.009), in-hospital death (9.7% versus 5.8%, P = 0.006), and discharge to a healthcare facility (60.9% versus 46.4%, P < 0.001). Controlling for Injury Severity Score, age, gender, and comorbidities, the association between lymphopenia and discharge to another facility (SNF/rehabilitation facility/ACH) (OR = 1.380 [1.041-1.830], P = 0.025) remained significant.
Lymphopenia on admission is associated with discharge requiring increased healthcare support. Routine lymphocyte count monitoring on admission may provide important prognostic information for BCWT patients.
淋巴细胞减少症导致危重病患者观察到的免疫抑制。然而，其在创伤免疫反应中的作用尚不清楚。在此，我们评估入院时淋巴细胞减少症是否与钝性胸壁创伤（BCWT）患者的不良结局相关。
在我们机构的创伤登记处中，确定了 2009 年 5 月至 2018 年 12 月期间入住我们的一级创伤中心的所有成人患者，其胸损伤简略评分（CAIS）≥2。纳入了在入院后 24 小时内采集的绝对淋巴细胞计数（ALC）的患者。排除了入院后 24 小时内死亡、入院时肠穿孔、穿透性创伤和烧伤的患者。收集了人口统计学、损伤特征、合并症、ALC、并发症和结局。淋巴细胞减少症定义为 ALC≤1000/µL。使用多变量分析评估 BCWT 的临床结局与淋巴细胞减少症之间的关联。P<0.05 被认为具有统计学意义。
共纳入 1394 例患者；69.7%为男性；44.3%为淋巴细胞减少症。在单变量分析中，淋巴细胞减少症与住院时间延长（11.6±10.2 与 10.1±11.4，P=0.009）、住院期间死亡（9.7%与 5.8%，P=0.006）和出院至医疗机构（60.9%与 46.4%，P<0.001）相关。在控制损伤严重程度评分、年龄、性别和合并症后，淋巴细胞减少症与出院至其他医疗机构（疗养院/康复设施/ACH）（比值比[OR]=1.380[1.041-1.830]，P=0.025）之间的关联仍然显著。
入院时的淋巴细胞减少症与需要增加医疗保健支持的出院相关。入院时常规监测淋巴细胞计数可能为 BCWT 患者提供重要的预后信息。
