Lymphopenic community acquired pneumonia, an unnoticed phenotype associated to mortality in non immuno-suppressed patients: a retrospective cohort study

Abstract

BackgroundThe role of neutrophil and lymphocyte counts as predictors of prognosis in Community Acquired Pneumonia (CAP) has not been appropriately studied.\n\nMethodsThis was a retrospective study to evaluate by multivariate regression analysis, the association between neutrophil and lymphocyte counts with mortality at 30-days post discharge in two large cohorts of hospitalized patients with CAP and no prior immunosupression: a multicentric with 1550 patients recruited at 14 hospitals in Spain and a unicentric with 2840 patients recruited at the Hospital Clinic-Barcelona.\n\nFindingsThe unicentric cohort accounted with a higher proportion of critically ill patients: 586 (20{middle dot}6%) vs 131 (8{middle dot}5%) and non survivors 245 (8{middle dot}6%) vs 74 (4{middle dot}8%). Lymphopenia (< 1000 lymphocytes/mm3) was present in the 52{middle dot}8% of the patients in both cohorts. A sub-group of lymphopenic patients, those with lymphocyte counts below decil 3 (677 lymphocytes/mm3 in the multicentric cohort and 651 lymphocytes/mm3 in the unicentric one), showed > 2-fold increase in the risk of mortality, independently of the CURB-65 score, critical illness and receiving an appropriated antibiotic treatment: (OR [CI95%], p) (2{middle dot}18 [1{middle dot}21- 3{middle dot}92], 0{middle dot}009) and (2{middle dot}33 [1{middle dot}61-3{middle dot}33], <0{middle dot}001) respectively. Neutrophil counts were not associated with mortality risk.\n\nInterpretationLymphopenia is present in a half of the patients with CAP needing of hospitalization, in absence of antecendents of immunosupression. Lymphopenic CAP with lymphocyte counts < 664 lymphocytes/mm3 constitutes a particular immunological phenotype of the disease which is associated to an increased risk of mortality.\n\nFundingCibeRes, 2009 Support to Research Groups of Catalonia 911, IDIBAPS, SEPAR, SVN