PMID- 25051284 OWN - NLM STAT- MEDLINE DCOM- 20150609 LR - 20220410 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 42 IP - 5 DP - 2014 Nov TI - Persistent lymphopenia after diagnosis of sepsis predicts mortality. PG - 383-91 LID - 10.1097/SHK.0000000000000234 [doi] AB - OBJECTIVE: The objective of this study was to determine whether persistent lymphopenia on the fourth day following the diagnosis of sepsis predicts mortality. METHODS: This was a single-center, retrospective cohort study of 335 adult patients with bacteremia and sepsis admitted to a large university-affiliated tertiary care hospital between January 1, 2010, and July 31, 2012. All complete blood cell count profiles during the first 4 days following the diagnosis of sepsis were recorded. The primary outcome was 28-day mortality. Secondary outcomes included development of secondary infections, 1-year mortality, and hospital and intensive care unit lengths of stay. RESULTS: Seventy-six patients (22.7%) died within 28 days. Lymphopenia was present in 28-day survivors (median, 0.7 x 10 cells/muL; interquartile range [IQR], 0.4-1.1 x 10 cells/muL) and nonsurvivors (median, 0.6 x 10 cells/muL; IQR, 0.4-1.1 x 10 cells/muL) at the onset of sepsis and was not significantly different between the groups (P = 0.35). By day 4, the median absolute lymphocyte count was significantly higher in survivors compared with nonsurvivors (1.1 x 10 cells/muL [IQR, 0.7-1.5 x 10 cells/muL] vs. 0.7 x 10 cells/muL [IQR, 0.5-1.0 x 10 cells/muL]; P < 0.0001). Using logistic regression to account for potentially confounding factors (including age, Acute Physiology and Chronic Health Evaluation II score, comorbidities, surgical procedure during the study period, and time until appropriate antibiotic administration), day 4 absolute lymphocyte count was found to be independently associated with 28-day survival (adjusted odds ratio, 0.68 [95% confidence interval, 0.51-0.91]) and 1-year survival (adjusted odds ratio, 0.74 [95% confidence interval, 0.59-0.93]). Severe persistent lymphopenia (defined as an absolute lymphocyte count of 0.6 x 10 cells/muL or less on the fourth day after sepsis diagnosis) was associated with increased development of secondary infections (P = 0.04). CONCLUSIONS: Persistent lymphopenia on the fourth day following the diagnosis of sepsis predicts early and late mortality and may serve as a biomarker for sepsis-induced immunosuppression. FAU - Drewry, Anne M AU - Drewry AM AD - Departments of *Anesthesiology and daggerSurgery, Washington University School of Medicine; double daggerDepartment of Pharmacy, Barnes-Jewish Hospital; and section signDepartment of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri. FAU - Samra, Navdeep AU - Samra N FAU - Skrupky, Lee P AU - Skrupky LP FAU - Fuller, Brian M AU - Fuller BM FAU - Compton, Stephanie M AU - Compton SM FAU - Hotchkiss, Richard S AU - Hotchkiss RS LA - eng GR - R01 GM044118/GM/NIGMS NIH HHS/United States GR - GM 44118/GM/NIGMS NIH HHS/United States GR - R37 GM044118/GM/NIGMS NIH HHS/United States GR - GM 55194/GM/NIGMS NIH HHS/United States GR - R01 GM055194/GM/NIGMS NIH HHS/United States GR - UL1 TR000448/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM MH - APACHE MH - Adult MH - Aged MH - Bacteremia/complications/immunology/mortality MH - Female MH - Humans MH - Immune Tolerance MH - Kaplan-Meier Estimate MH - Length of Stay/statistics & numerical data MH - Leukocyte Count MH - Lymphopenia/*etiology/immunology/mortality MH - Male MH - Middle Aged MH - Missouri/epidemiology MH - Opportunistic Infections/complications/immunology/mortality MH - Prognosis MH - Retrospective Studies MH - Sepsis/*complications/immunology/mortality PMC - PMC4362626 MID - NIHMS611234 COIS- Conflicts of Interest Anne Drewry, Lee Skrupky, Brian Fuller, Navdeep Samra, and Stephanie Compton have no competing interests to declare. EDAT- 2014/07/23 06:00 MHDA- 2015/06/10 06:00 PMCR- 2015/11/01 CRDT- 2014/07/23 06:00 PHST- 2014/07/23 06:00 [entrez] PHST- 2014/07/23 06:00 [pubmed] PHST- 2015/06/10 06:00 [medline] PHST- 2015/11/01 00:00 [pmc-release] AID - 10.1097/SHK.0000000000000234 [doi] PST - ppublish SO - Shock. 2014 Nov;42(5):383-91. doi: 10.1097/SHK.0000000000000234.