Persistent Lymphopenia as a Predictor of in-Hospitality in Septic Patients at Dr. Sardjito Hospital

Juvita Kurniawan

doi:10.22146/actainterna.61348

Persistent Lymphopenia as a Predictor of in-Hospitality in Septic Patients at Dr. Sardjito Hospital

https://doi.org/10.22146/actainterna.61348

Juvita Kurniawan^(1*)

(1) Universitas Gadjah Mada
(*) Corresponding Author

Abstract

Background: Sepsis, a life-threatening organ dysfunction caused by deregulation of body response to an infection with a high mortality rate. Pro-inflammatory cytokines are related to early mortality related sepsis, and immune dysfunction and suppression characterized by lymphocyte loss are related to late mortality. Persistent lymphopenia is a good biomarker for immunosuppression and predicts mortality in sepsis patients. Lymphocyte counts are easily measured and cheaper than other inflammation marker for sepsis.

Aims: The objective of this study was to determine whether persistent lymphopenia has a predictive value for mortality in septic patients at Dr. Sardjito General Hospital.

Methods: This study was a retrospective cohort study, sepsis and lymphogenic patients admitted to Internal Medicine ward between January 1, 2016 and December 31, 2017. Lymphocytes were count at day 1 and 4 following the diagnosis of sepsis. Persistent lymphopenia was defined as an absolute lymphocyte count of 1.62x10/μL or less on day 4. The primary outcome was mortality at the end of hospitalization.

Results: 126 adult patients, 101 with persistent lymphopenia, 25 non-persistent lymphopenia, 47 patients died (37.3%). Patients with persistent lymphopenia significantly at risk of death (P=0.003, OR 5.66, 95% CI 1.59-20.13) than non-persistent lymphopenia. Logistic regression was used to account for potential confounding factors, persistent lymphopenia (p = 0.003, OR 8.01, 95% CI 2.04-31.45) and skin and soft tissue infection (p= 0.017, OR 2.94, 95% CI 1.21-7.14) were significantly associated with mortality in sepsis patients at Dr. Sardjito General Hospital.

Conclusion: Persistent lymphopenia predicts mortality in adult patients with sepsis at Dr. Sardjito GeneralHospital.

Keywords

Persistent lymphopenia, Predictor of mortality, Sepsis

Full Text:

PDF

References

Singer, M., Deutschman, C.S., Seymour, C.W., Shankar-Hari, M., Annane, D., Bauer, M., et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). J Am Med Assoc. 2016;315:801–810. 2. Fleischmann, C., Scherag, A., Adhikari,N.K.J., Hartog, C.S.,Tsaganos, T., Schlattmann, P., et al. Assessment of global incidence and mortality of hospital-treated sepsis. Currentestimates and limitations. Am J Respir Crit Care Med. 2016; 193:259– 272. 3. Stearns-Kurosawa, D.J., Osuchowski,M.F., Valentine, C., Kurosawa, S., Remick, D.G. The Pathogenesis of sepsis. Annu. Rev. Pathol. Mech. Dis. 2011; 6: 19-48. 4. Inoue, S., Suzuki-Utsunomiya, K., Okada, Y., Taira, T., Iida, Y., Miura, N., et al. Reduction of immunocompetent T cells followed by prolonged lymphopenia in severe sepsis in the elderly. Crit Care. 2013;41(3): 810-819. 5. Drewry, A.M., Samra, N., Skrupky, L.P., Fuller, B.M., Compton, S.M., Hotchkiss, R.S. Persistent Lymphopenia after diagnosis of sepsis predicts mortality. Shock. 2014; 42 (5): 383-39. 6. Gatta, A., Verardo, A., Bolognesi, M. Hypoalbuminemia. Intern EmeRg Med. 2012; 7(Suppl 3): S193-199. 7. Mazzone, A., Dentali, F., Regina, M.L., Foglia, E., Gambarcota, M., Garagiola, E., et al. Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients admitted to Internal Medicine Units. Medicine. 2016; 95 (4):15. 8. Polat, G., Ugan, R.A., Cardici, E., Halici, Z. Sepsis and septic shock:current treatment strategies and new approaches. The Eurasian Journal of Medicine. 2017; 49:53-8 9. Angus, D.C., van der Poll, T.. Severe sepsis and septic shock. N Engl J Med. 2013; 369(9):840-851. 10. Asdie, R.H., Octavianto, R.A., Pasaribu, F.Z., Wirawan, A.D., Murti, W.W., Suharyanto, et al. In: Nirwati H, Annisa L, editors. Kultur Darah, Skor SOFA, dan SAPS II untuk Memprediksi Tingkat Keparahan dan Kematian akibat Sepsis. Proceedings of Annual Scientific Meeting (ASM) Pokja Mikrobiologi; 2017 April 07; Yogyakarta: Departemen Mikrobiologi Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta. 11. Le Tulzo, Y., Pangault, C., Gacouin, A., Guilloux, V., Tribut, O., Amiot, L., et al., 2002. Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock. 2002; 18:487–494. 12. Hutchins, N.A., Usinger, J., Hotchkiss, R.S., Ayala, A., 2014. The new normal: immunomodulatory agents against sepsis immune suppression. Trends in molecular medicine. 2014; 20 (4): 224-233. 13. Chung, K.P., Chang, H.T., Lo, S.C., Chang, L.Y., Lin, S.Y., Cheng, A., et al. Severe lymphopenia is associated with elevated plasma interleukin-15 levels and increased mortality during severe sepsis. Shock. 2015; 43:569–575. 14. Esper, A.M., Moss, M., Martin, G. The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study. Crit Care. 2009; 13(1):R18 15. Lipsky, B.A., Tabak, Y.P., Johannes, R.S., Vo, L., Hyde, L., Weigelt, J.A. Skin and soft tissue infections in hospitalized patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia. 2010; 53: 914-923. 16. Vulliamy, P.E., Perkins, Z.B., Brohi, K., Manson, J., 2016. Persistent Lymphopenia is an independent predictor of mortality in critically ill emergency general surgical patients. Eur J Trauma Emerg Surgery. 42:755-760.

DOI: https://doi.org/10.22146/actainterna.61348