Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

Abstract

Background 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). Methods 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. Results 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. Conclusions 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.

Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor of 30-Day Mortality of Intracerebral Hemorrhage Patients: a Validation Cohort Study

“…Decreased lymphocyte count has been reported to be associated with 90-day mortality (Morotti et al 2017b ) and poor neurological recovery (Giede-Jeppe et al 2016 ) in ICH patients. Lower lymphocyte count in non-survivors identified in the current study is consistent with these previous reports.…”

Hematological factors predicting mortality in patients with traumatic epidural or subdural hematoma undergoing emergency surgical evacuation

“…Changes in lymphocyte counts during the course of ICH have been reported. Admission lymphocytopenia [ 25 , 26 ] as well as the development of lymphocytopenia during treatment were related to an unfavorable outcome. [ 25 ] Lymphocyte dynamics during the course of TBI have been studied previously.…”

Association between cholesterol levels and infections after ischemic stroke

“…Finally, the relationship between lipids, inflammation and infections is complex and we were able to adjust our analysis only for admission leukocyte count. Further research efforts are needed to explore the interactions between cholesterol levels and markers of stroke-associated immunodepression and inflammation such as lymphocyte count [19] and C-reactive protein [20].…”