Clinical significance of lymphocytopenia in patients hospitalized with pneumonia caused by influenza virus

Bellelli, Valeria; d’Ettorre, Gabriella; Celani, Luigi; Borrazzo, Cristian; Ceccarelli, Giancarlo; Venditti, Mario

doi:10.1186/s13054-019-2608-1

Cited by 40 publications

(38 citation statements)

References 5 publications

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“…Several studies have reported lymphocytopenia in severe influenza [27,29,30]. Shi et al suggested that lymphocytopenia was an early and reliable predictor of mortality in patients diagnosed with influenza A(H1N1)pdm09 pneumonia [27].…”

Section: Discussionmentioning

confidence: 99%

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Liang

Han

et al. 2020

Respir Res

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Background: The pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) score have been shown to predict mortality in community-acquired pneumonia. Their ability to predict influenza-related pneumonia, however, is less well-established. Methods: A total of 693 laboratory-confirmed FluA-p patients diagnosed between Jan 2013 and Dec 2018 and recruited from five teaching hospitals in China were included in the study. The sample included 494 patients in the derivation cohort and 199 patients in the validation cohort. The prediction rule was established based on independent risk factors for 30-day mortality in FluA-p patients from the derivation cohort. Results: The 30-day mortality of FluA-p patients was 19.6% (136/693). The FluA-p score was based on a multivariate logistic regression model designed to predict mortality. Results indicated the following significant predictors (regression statistics and point contributions toward total score in parentheses): blood urea nitrogen > 7 mmol/L (OR 1.604, 95% CI 1.150-4.492, p = 0.040; 1 points), pO 2 /F i O 2 ≤ 250 mmHg (OR 2.649, 95% CI 1.103-5.142, p = 0.022; 2 points), cardiovascular disease (OR 3.967, 95% CI 1.269-7.322, p < 0.001; 3 points), arterial PH < 7.35 (OR 3.959, 95% CI 1.393-7.332, p < 0.001; 3 points), smoking history (OR 5.176, 95% CI 2.604-11.838, p = 0.001; 4 points), lymphocytes < 0.8 × 10 9 /L (OR 8.391, 95% CI 3.271-16.212, p < 0.001; 5 points), and early neurominidase inhibitor therapy (OR 0.567, 95% CI 0.202-0.833, p = 0.005; − 2 points). Seven points was used as the cut-off value for mortality risk stratification. The model showed a sensitivity of 0.941, a specificity of 0.762, and overall better predictive performance than the PSI risk class (AUROC = 0.908 vs 0.560, p < 0.001) and the CURB-65 score (AUROC = 0.908 vs 0.777, p < 0.001). Conclusions: Our results showed that a FluA-p score was easy to derive and that it served as a reliable prediction rule for 30-day mortality in FluA-p patients. The score could also effectively stratify FluA-p patients into relevant risk categories and thereby help treatment providers to make more rational clinical decisions.

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Section: Discussionmentioning

confidence: 99%

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Liang

Han

et al. 2020

Respir Res

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“…Lymphocytopenia was considered as a risk factor for mortality in patients with pneumonia caused by influenza virus. [38] Decreased monocytes was found to have a marginal difference between the survivors and the non-survivors, which may also be a prognostic factor. So far, few studies have been reported, and further large sample validation is required.…”

Section: Discussionmentioning

confidence: 92%

Comprehensive analyses of immunoglobulin proteome and clinical variables identify biomarkers to predict mortality in patients with influenza-associated lower respiratory tract infection

Teng

Wang

Zhang

et al. 2020

Preprint

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Background: Influenza-associated lower respiratory tract infection (I-LRTI) brings a heavy clinical burden, and clinicians lack an effective prognostic evaluation system to control disease progression. Methods: This was a prospective, observational study, and the endpoint was 28-day mortality. Plasma microarrays were used for quantitative analysis of immunoglobulin (Ig) and its subclasses. Prognostic factors from Ig and clinical variables in the patients with I-LRTI were identified to create a prediction model. Results: To address this issue, we prospectively and observationally studied the difference of immunoglobulin proteome and clinical variables between survivors and non-survivals in 107 patients with influenza-associated lower respiratory tract infection (I-LRTI) selected from four hospitals affiliated to Capital Medical University. The results identified 17 variables with significant or marginally statistical differences by univariate analysis, including lymphocyte count (LY), monocytes count (MO), CD3 + CD4 + T-cell count, CD3 + CD8 + T-cell count, IgA, IgA1, IgG2, IgG4, CRP, PCT, D-dimer, oxygenation index, glycosylated hemoglobin, lactic acid (LAC), base excess of blood, lactic dehydrogenase, and α-hydroxybutyrate dehydrogenase. Furthermore, we analyzed the correlations of all the variables by hierarchical clustering analysis in which different functional modules were formed between survival and non-survival groups that are associated with the immunity and severe infection. At last, we built a prediction model with nine variables (D-dimer, days from onset to ED, IgA, IgG2, LAC, LY, MO, Staphylococcus aureus co-infection and age), with which the AUC value of 0.810 (95% CI 0.755-0.839) was achieved with the evaluation of LOO cross validation. The predictive model was further validated by disease severity evaluation. Conclusion: Lethal bacterial (especially S. aureus ) co-infection was associated with cellular immunity, oxygenation index, HbA1C and age. The combined prediction model with D-dimer, Days from onset to ED, IgA, IgG2, LAC, LY, MO, S.aureus co-infection and age demonstrate the predictive mortality powerfully in patients with I-LRTI.

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“…Lymphopenia is commonly assessed in most viral infections, speci cally, type A and B in uenza [20]. According to a previous study, lymphopenia was also observed in SARS and MERS [21].…”

Section: Discussionmentioning

confidence: 95%

Predictive Factors of Severe Coronavirus Disease 2019 in Previously Healthy Young Adults: A Single-Center, Retrospective Study

Zhou

Huang

et al. 2020

Preprint

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Background: Several previously healthy young adults have developed Coronavirus Disease 2019 (COVID-19), and a few of them progressed to the severe stage. However, the factors are not yet determined. Method: We retrospectively analyzed 123 previously healthy young adults diagnosed with COVID-19 from January to March 2020 in a tertiary hospital in Wuhan. Patients were classified as having mild or severe COVID-19 based on their respiratory rate, SpO2, and PaO2/FiO2 levels. Patients’ symptoms, computer tomography (CT) images, preadmission drugs received, and the serum biochemical examination on admission were compared between the mild and severe groups. Significant variables were enrolled into logistic regression model to predict the factors affecting disease severity. A receiver operating characteristic (ROC) curve was applied to validate the predictive value of predictors. Result: Age; temperature; anorexia; and white blood cell count, neutrophil percentage, platelet count, lymphocyte count, C-reactive protein, aspartate transaminase, creatine kinase, albumin, and fibrinogen values were significantly different between patients with mild and severe COVID-19 (P<0.05). Logistic regression analysis confirmed that lymphopenia (P=0.010) indicated severe prognosis in previously healthy young adults with COVID-19, with the area under the curve (AUC) was 0.791(95% Confidence Interval (CI) 0.704–0.877)(P<0.001). Conclusion: For previously healthy young adults with COVID-19, lymphopenia on admission can predict severe prognosis.

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Clinical significance of lymphocytopenia in patients hospitalized with pneumonia caused by influenza virus

Cited by 40 publications

References 5 publications

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Comprehensive analyses of immunoglobulin proteome and clinical variables identify biomarkers to predict mortality in patients with influenza-associated lower respiratory tract infection

Predictive Factors of Severe Coronavirus Disease 2019 in Previously Healthy Young Adults: A Single-Center, Retrospective Study

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