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Open AccessArticle

Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock

1
Department of Intensive Care Medicine, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
2
Laboratory of Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid, Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
3
Intensive Care Medicine, Hospital Parc Taulí-Sabadell, 08208 Sabadell, Spain
4
Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de salud Carlos III (ISCIII), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
5
Grup d’Estudi al Maresme de la Pneumònia Adquirida a la Comunitat (GEMPAC) acreditat per la AGAUR (expedient 2014 SGR 1018), Consorci Sanitari del Maresme, 08204 Mataró, Spain
6
Programa de Doctorat en Medicina de la Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebrón 119-129, 08035 Barcelona, Spain
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(5), 754; https://doi.org/10.3390/jcm8050754
Received: 3 April 2019 / Revised: 20 May 2019 / Accepted: 23 May 2019 / Published: 27 May 2019
Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock. View Full-Text
Keywords: community-acquired pneumonia; mortality risk; leukocyte subclasses counts; neutrophils; lymphocytes community-acquired pneumonia; mortality risk; leukocyte subclasses counts; neutrophils; lymphocytes
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Güell, E.; Martín-Fernandez, M.; De la Torre, M.C.; Palomera, E.; Serra, M.; Martinez, R.; Solsona, M.; Miró, G.; Vallès, J.; Fernández, S.; Cortés, E.; Ferrer, V.; Morales, M.; Yébenes, J.C.; Almirall, J.; Bermejo-Martin, J.F. Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock. J. Clin. Med. 2019, 8, 754.

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