持续炎症和淋巴细胞减少症与机械通气延长患者的撤机结局。

Persistent inflammation and lymphopenia and weaning outcomes of patients with prolonged mechanical ventilation.

机构信息

Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.1, Chang-Te Street, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, Taiwan.

出版信息

Respir Investig. 2024 Nov;62(6):935-941. doi: 10.1016/j.resinv.2024.08.001. Epub 2024 Aug 24.

DOI:10.1016/j.resinv.2024.08.001

PMID:39182398

Abstract

BACKGROUND

Weaning outcomes of patients receiving mechanical ventilation (MV) are affected by multiple factors. A clinical feature of critically ill patients is the presence of lymphopenia, however the clinical significance of lymphopenia in patients receiving prolonged MV remains unclear.

METHODS

We enrolled patients who received at least 21 consecutive days of MV in a medical center in Taiwan between 2007 and 2016. Patients with and without lymphopenia (mean count <1000/μL) were compared after propensity score matching.

RESULTS

Of the 3460 patients included in the analysis, 1625 (47.0%) were liberated from MV within 100 days. Lymphopenia and severe lymphopenia (mean count <500/μL) during the first 21 days of MV were common (52.9% and 14.5%, respectively), and restricted cubic spline analysis showed a significant reduction in weaning success when the lymphocyte count dropped below 1000/μL. After propensity score matching, the patients with lymphopenia during the third week had a lower rate of weaning success within 100 days (p = 0.005) and a higher in-hospital mortality rate (p = 0.001) than those without lymphopenia. The lymphopenia group also had significantly reduced platelet (p < 0.001) and albumin (p < 0.001) levels.

CONCLUSIONS

Our findings suggest that lymphopenia during the first 3 weeks may be a marker of poor weaning outcomes in patients with prolonged MV.

摘要

背景

接受机械通气（MV）的患者的撤机结果受多种因素影响。危重病患者的临床特征之一是存在淋巴细胞减少症，然而，接受长时间 MV 的患者淋巴细胞减少症的临床意义尚不清楚。

方法

我们纳入了 2007 年至 2016 年期间在台湾一家医学中心接受至少 21 天连续 MV 的患者。对有和无淋巴细胞减少症（平均计数<1000/μL）的患者进行倾向评分匹配后进行比较。

结果

在纳入分析的 3460 名患者中，有 1625 名（47.0%）在 100 天内成功撤机。MV 开始后的前 21 天中，淋巴细胞减少症和严重淋巴细胞减少症（平均计数<500/μL）很常见（分别为 52.9%和 14.5%），限制立方样条分析显示，当淋巴细胞计数降至 1000/μL 以下时，撤机成功率显著降低。经过倾向评分匹配后，第三周出现淋巴细胞减少症的患者在 100 天内撤机成功率较低（p=0.005），住院死亡率较高（p=0.001），与无淋巴细胞减少症的患者相比。淋巴细胞减少症组的血小板（p<0.001）和白蛋白（p<0.001）水平也显著降低。