Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage.
Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage.
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DOI：
10.1007/s12028-016-0367-2
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发表时间：
2017-04
影响因子：
3.5
通讯作者：
Rosand J
中科院分区：
文献类型：
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作者：
Morotti A;Marini S;Jessel MJ;Schwab K;Kourkoulis C;Ayres AM;Gurol ME;Viswanathan A;Greenberg SM;Anderson CD;Goldstein JN;Rosand J
淋巴细胞减少症越来越多地被认为是急性疾病的结果，并可能易于感染。我们调查了自发性脑出血(ICH)患者入院时淋巴细胞减少(AL)是否与感染并发症风险增加和预后不良有关。我们回顾分析了1994至2015年间确定的前瞻性收集的脑出血患者队列。我们确定受试者在发病后24小时内取得淋巴细胞计数，AL定义为淋巴细胞计数1000/µL，通过回顾图表评估感染并发症。用多变量Logistic回归分析AL、感染和死亡率之间的关系。在符合纳入标准的2014名患者中，548名(27.2%)患有AL，605名(30.0%)出现感染并发症。90天病死率为36.9%。AL患者有更大的血肿体积，更高的脑室出血频率，以及更低的格拉斯哥昏迷评分(均P<；0.001)。AL与肺炎[优势比(OR)1.97，95%可信区间(CI)1.50~2.58，P&t；0.001]和多重感染(OR 1.84，95%CI 1.24~2.71，P=0.003)的风险增加独立相关。在调整混杂因素后，AL也是90天死亡率的独立预测因素(OR1.55，95%CI1.18-2.04，p=0.002)。急性脑出血在脑出血患者中很常见，独立地与感染并发症的风险增加和不良预后相关。对于脑出血合并AL的患者，预防性使用抗生素是否能改善预后还需要进一步的研究。
Lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). We retrospectively analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. We identified subjects with lymphocyte count obtained within 24 h from onset, and AL was defined as lymphocyte count < 1000/µL. Infectious complications were assessed through retrospective chart review. Association between AL, infections, and mortality was investigated using multivariable logistic regression. Of the 2014 patients meeting inclusion criteria, 548 (27.2%) had AL and 605 (30.0%) developed an infectious complication. Case-fatality at 90 days was 36.9%. Patients with AL had larger hematoma volumes, higher frequency of intraventricular hemorrhage, and lower Glasgow Coma Scale score on presentation (all p < 0.001). AL was independently associated with increased risk of pneumonia [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.50–2.58, p < 0.001] and multiple infections (OR 1.84, 95% CI 1.24–2.71, p = 0.003). AL was also an independent predictor of 90-day mortality (OR 1.55, 95% CI 1.18–2.04, p = 0.002) after adjusting for confounders. AL is common in ICH patients and independently associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.