淋巴细胞减少症对脓毒性休克长期死亡率的影响,一项回顾性观察研究。

J. Rico-Feijoó , J.F. Bermejo , A. Pérez-González , S. Martín-Alfonso , C. Aldecoa
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引用次数: 0

摘要

背景和目的:感染诊断,即脓毒性休克诊断,一直由白细胞计数和蛋白质生物标志物来定性。脓毒性休克的死亡率一直居高不下(20%-50%),并且长期呈上升趋势。脓毒症的定义不包括白细胞计数,而淋巴细胞减少症在短期内与脓毒症的死亡率有关。免疫抑制和败血症导致的长期死亡率增加尚未得到证实。本研究的目的是将脓毒性休克期间发生的淋巴细胞减少症及其未恢复情况与患者两年后的死亡率联系起来:患者和方法:332 名被诊断为脓毒性休克的老年患者。根据白细胞、中性粒细胞和淋巴细胞计数以及淋巴细胞减少症恢复能力(LRec)分析28天和2年后的死亡率:结果:74.1%的患者出现淋巴细胞减少症,73.5%的患者在重症监护室住院期间病情未见好转。28天和2年后的死亡率分别为31.0%和50.3%。淋巴细胞减少可预测早期死亡率(OR 2.96),LRec可预测晚期死亡率(OR 3.98)。长期死亡率与淋巴细胞减少症相关(HR 1.69):结论:在老年脓毒性休克患者中,28 天死亡率与淋巴细胞减少和中性粒细胞增多有关,而 LRec 与 2 年死亡率有关;这可能代表了脓毒性休克后两种不同的行为表型。
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Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study

Background and objective

The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%–50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.

Patients and methods

Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).

Results

A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69).

Conclusions

In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.

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