Nonviral infection-related lymphocytopenia for the prediction of adult sepsis and its persistence indicates a higher mortality

Abstract

Sepsis is a life-threatening disease that affects 30 million people worldwide each year. Despite the rapid advances in medical technology and organ support systems, it is still difficult to reduce the mortality rate. Early and rapid diagnosis is crucial to improve the treatment outcome. The aim of this study was to investigate the prediction efficiency of lymphopenia and other clinical markers, such as white blood cell (WBC), neutrophil count (N#), procalcitonin (PCT), and arterial lactic acid (Lac) in the diagnosis and prognosis assessment for adult patients with nonviral infection-related sepsis. A total of 77 sepsis- and 23 non-sepsis adult patients were enrolled in this study from September 2016 to September 2018. Daily lymphocyte count (Lym) of the patients was calculated until discharge or death. The diagnostic performance of the Lym and other biomarkers were compared using the area under the receiver operating characteristic curve (ROC) value. The level of Lym was decreased significantly in the sepsis group. Lym had a high diagnostic performance for sepsis, with an area under the curve (AUC) value of 0.971 (95% CI = 0.916–0.994). The diagnostic efficacy of Lym was more significant than WBC, N#, and PCT ( P < .001). The results showed that the 28-day mortality rate of patients with continuous Lym <0.76 × 10 9 /L was 39.66%, which significantly higher than patients without persistent lymphocytopenia. Lym is a promising, low cost, fast, and easily available biomarker for the diagnosis of sepsis. When nonviral infection is suspected and lymphocytopenia level is lower than the optimal cut-off (0.76 × 10 9 /L) value, high vigilance is required for sepsis. The persistence with the lymphocytopenia cut-off value (<0.76 × 10 9 /L) >3 days indicates a higher 28-day mortality rate.

A lethal model of Leptospira infection in hamster nasal mucosa

“…This is consistent with the rapid development of a hamster model similar to human leptospirosis, which directly leads to severe liver and kidney dysfunction [ 37 , 38 ]. A large number of leptospires could be detected in the blood, and haematological analysis found that the percentage of neutrophils increased and the percentage of lymphocytes decreased, which was a manifestation of severe sepsis [ 39 , 40 ].…”

Lymphopenia Predicts Early Mortality in Cancer Patients with Sepsis, A Retrospective Study of Medical Records

“…ALCs usually decrease to similar levels in survivors and non-survivors in the early stages of sepsis; however, it experiences lymphocyte recovery in survivors, while that of non-survivors remains low [21]. Previous studies showed that lymphopenia is effective for the early diagnosis of sepsis and indicates a higher mortality [22]. Additionally, ALCs after esophagectomy decreased more than that after colorectal cancer surgery, whilst lymphopenia did not occur after minor surgical procedures [23,24].…”

Developing a new sepsis screening tool based on lymphocyte count, international normalized ratio and procalcitonin (LIP score)

“…A major feature of immunosuppression in sepsis is immune cell apoptosis, similar to the decreased levels of circulating lymphocytes 6 . Apoptosis, autophagy and other factors contribute to the early reduction in lymphocyte count [6][7][8] . In addition, procoagulant dysfunction is another important feature of sepsis, and many studies have revealed a close relationship between the infectious inflammatory response and coagulation function [9][10][11][12] .…”