Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
VA Center for Clinical Management Research, Ann Arbor, MI, United States.
Front Immunol. 2023 Feb 28;14:1133351. doi: 10.3389/fimmu.2023.1133351. eCollection 2023.
Predicting long-term outcomes in sepsis survivors remains a difficult task. Persistent inflammation post-sepsis is associated with increased risk for rehospitalization and death. As surrogate markers of inflammation, complete blood count parameters measured at hospital discharge may have prognostic value for sepsis survivors.
To determine the incremental value of complete blood count parameters over clinical characteristics for predicting 90-day outcomes in sepsis survivors.
Electronic health record data was used to identify sepsis hospitalizations at United States Veterans Affairs hospitals with live discharge and relevant laboratory data (2013 to 2018). We measured the association of eight complete blood count parameters with 90-day outcomes (mortality, rehospitalization, cause-specific rehospitalizations) using multivariable logistic regression models.
We identified 155,988 eligible hospitalizations for sepsis. Anemia (93.6%, N=142,162) and lymphopenia (28.1%, N=29,365) were the most common blood count abnormalities at discharge. In multivariable models, all parameters were associated with the primary outcome of 90-day mortality or rehospitalization and improved model discrimination above clinical characteristics alone (likelihood ratio test, p<0.02 for all). A model including all eight parameters significantly improved discrimination (AUROC, 0.6929 v. 0.6756) and reduced calibration error for the primary outcome. Hemoglobin had the greatest prognostic separation with a 1.5 fold increased incidence of the primary outcome in the lowest quintile (7.2-8.9 g/dL) versus highest quintile (12.70-15.80 g/dL). Hemoglobin and neutrophil lymphocyte ratio provided the most added value in predicting the primary outcome and 90-day mortality alone, respectively. Absolute lymphocyte count added little value in predicting 90-day outcomes.
The incorporation of discharge complete blood count parameters into prognostic scoring systems could improve prediction of 90-day outcomes. Hemoglobin had the greatest prognostic value for the primary composite outcome of 90-day rehospitalization or mortality. Absolute lymphocyte count provided little added value in multivariable model comparisons, including for infection- or sepsis-related rehospitalization.
预测脓毒症幸存者的长期预后仍然是一项艰巨的任务。脓毒症后持续存在的炎症与再住院和死亡的风险增加有关。全血细胞计数参数作为炎症的替代标志物，在出院时测量可能对脓毒症幸存者具有预后价值。
确定全血细胞计数参数对预测脓毒症幸存者 90 天结局的临床特征的增量价值。
使用美国退伍军人事务部医院的电子健康记录数据，确定 2013 年至 2018 年期间有存活出院和相关实验室数据的脓毒症住院患者。我们使用多变量逻辑回归模型测量了 8 种全血细胞计数参数与 90 天结局（死亡率、再住院、特定原因再住院）的相关性。
我们确定了 155988 例符合条件的脓毒症住院患者。贫血（93.6%，N=142162）和淋巴细胞减少症（28.1%，N=29365）是出院时最常见的血细胞计数异常。在多变量模型中，所有参数均与 90 天死亡率或再住院的主要结局相关，并且优于单独的临床特征（似然比检验，p<0.02）。包括所有 8 个参数的模型显著提高了主要结局的区分度（AUROC，0.6929 与 0.6756）并降低了校准误差。血红蛋白的预后分离度最大，最低五分位数（7.2-8.9 g/dL）与最高五分位数（12.70-15.80 g/dL）相比，主要结局的发生率增加了 1.5 倍。血红蛋白和中性粒细胞淋巴细胞比率分别在预测主要结局和 90 天死亡率方面提供了最大的附加值。绝对淋巴细胞计数对预测 90 天结局的增值作用不大。
将出院时的全血细胞计数参数纳入预后评分系统可能会提高对 90 天结局的预测能力。血红蛋白对 90 天再住院或死亡率的主要复合结局具有最大的预后价值。绝对淋巴细胞计数在多变量模型比较中几乎没有附加值，包括感染或脓毒症相关的再住院。
