Association of prior lymphopenia with mortality in pneumonia: a cohort study in UK primary care.
Association of prior lymphopenia with mortality in pneumonia: a cohort study in UK primary care.
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DOI：
10.3399/bjgp20x713981
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Payne R
中科院分区：
文献类型：
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作者：
Hamilton F;Arnold D;Payne R
感染（如肺炎）期间淋巴细胞减少症（淋巴细胞计数减少）很常见，并与死亡率增加有关。关于发生感染前淋巴细胞计数与死亡风险之间的关系知之甚少。确定发生肺炎的淋巴细胞减少症患者死亡风险是否增加。一项在临床实践研究数据链（CPRD）中设置的队列研究，与初级保健中的国家死亡记录相关。该数据库代表英国人口，并从常规记录中提取。从1998年1月至2019年1月，纳入了年龄>50岁的肺炎诊断患者。采用至事件发生时间（多变量考克斯回归）方法，校正年龄、性别、社会因素和淋巴细胞减少症的潜在原因，测量淋巴细胞计数与死亡率之间的关系。主要分析使用肺炎前的最近一次检查。主要结局为28天全因死亡率。共纳入40909名肺炎患者，其中28556人在肺炎前进行了淋巴细胞计数检测（检测和诊断之间的中位时间为677天）。当淋巴细胞计数分类时，（0-1 × 109个细胞/L、1-2 × 109个细胞/L、2-3 × 109个细胞/L、>3 × 109个细胞/L，从未检测），28天和1年死亡率差异显著：28天死亡率分别为14%、9.2%、6.5%、6.1%和25%，1年死亡率分别为41%、29%、22%、20%和52%。在多变量考克斯回归分析中，淋巴细胞计数降低与死亡风险增加一致相关。淋巴细胞减少症是初级保健肺炎死亡率的独立预测因子。与较高计数相比，即使是低正常值淋巴细胞减少症（1-2 × 109个细胞/L）也与短期和长期死亡率增加相关。
Lymphopenia (reduced lymphocyte count) during infections, such as pneumonia, is common and is associated with increased mortality. Little is known about the relationship between lymphocyte count before developing infections and mortality risk. To identify whether patients with lymphopenia who develop pneumonia have increased risk of death. A cohort study set in the Clinical Practice Research Datalink (CPRD) linked to national death records, in primary care. This database is representative of the UK population and is extracted from routine records. Patients aged >50 years with a pneumonia diagnosis were included from January 1998 until January 2019. The relationship between lymphocyte count and mortality was measured, using a time-to-event (multivariable Cox regression) approach, adjusted for age, sex, social factors, and potential causes of lymphopenia. The primary analysis used the most recent test before pneumonia. The primary outcome was 28-day, all-cause mortality. A total of 40 909 participants with pneumonia were included, with 28 556 having had a lymphocyte count test before pneumonia (median time between test and diagnosis was 677 days). When lymphocyte count was categorised (0–1 × 109 cells/L, 1–2 × 109 cells/L, 2–3 × 109 cells/L, >3 × 109 cells/L, never tested), both 28-day and 1-year mortality varied significantly: 14%, 9.2%, 6.5%, 6.1%, and 25%, respectively, for 28-day mortality, and 41%, 29%, 22%, 20%, and 52% for 1-year mortality. In multivariable Cox regression, lower lymphocyte count was consistently associated with increased hazard of death. Lymphopenia is an independent predictor of mortality in primary care pneumonia. Even low–normal lymphopenia (1–2 × 109 cells/L) is associated with an increase in short- and long-term mortality compared with higher counts.