Prognostic value of lymphocyte count for in-hospital mortality in patients with severe AECOPD

Abstract

Background Patients with severe acute exacerbations of chronic obstructive pulmonary disease often have a poor prognosis. Biomarkers can help clinicians personalize the assessment of different patients and mitigate mortality. The present study sought to determine if the lymphocyte count could act as a risk factor for mortality in individuals with severe AECOPD. Methods A retrospective study was carried out with 458 cases who had severe AECOPD. For analysis, patients were divided into two groups on the basis of lymphocyte count: < 0.8 × 109/L and ≥ 0.8 × 109/L. Results Patients who fulfilled the criteria for inclusion were enrolled, namely 458 with a mean age of 78.2 ± 8.2 years. Of these patients, 175 had a low lymphocyte count. Compared to patients with normal lymphocyte counts, those with low counts were older (79.2 ± 7.4 vs. 77.5 ± 8.6 years, p = 0.036), had lower activities of daily living scores on admission (35.9 ± 27.6 vs. 47.5 ± 17.1, p < 0.001), and had a greater need for home oxygen therapy (84.6 vs. 72.1%, p = 0.002). Patients with low lymphocytes had higher mortality rates during hospitalization (17.1 vs. 7.1%, p = 0.001), longer hospital stay (median [IQR] 16 days [12–26] vs. 14 days [10–20], p = 0.002) and longer time on mechanical ventilation (median [IQR] 11.6 days [5.8–18.7] vs. 10.9 days [3.8–11.6], p < 0.001). The logistic regression analysis showed lymphocyte count < 0.8 × 109/L was an independent risk factor associated with in-hospital mortality (OR 2.74, 95%CI 1.33–5.66, p = 0.006). Conclusion Lymphocyte count could act as a predictor of mortality in patients with severe AECOPD.

Clinical relevance of blood urea nitrogen to serum albumin ratio for predicting bacteremia in very young children with febrile urinary tract infection

“…This study revealed that lower lymphocyte level was also an independent risk factor for bacteremia. Previous studies have shown that low lymphocyte counts are associated with poor prognosis in acute and chronic inflammatory conditions such as sepsis, cancer, and cardiovascular and pulmonary diseases [22][23][24]. However, it has not yet fully understood how low lymphocyte causes immune system abnormalities in patients with pediatric UTI and increases bacteremia [25,26].…”

Controlling Nutritional Status (CONUT) Score as a Potential Prognostic Indicator of In-Hospital Mortality, Sepsis and Length of Stay in an Internal Medicine Department

“…A possible explanation is that hypoalbuminemia leads to oxidative stress with cellular damage and apoptosis. Together with albumin dosage, a low TC and lymphocyte count are also associated with higher mortality, reflecting a deterioration in nutritional status and a decreased immune and inflammatory status [ 26 , 27 ]. The CONUT score carried out at the moment of admission and represented a vicious cycle well; indeed, patients with multimorbidity tend to suffer malnutrition through many mechanisms, such as fluid retention, long bed stay, lack of appetite leading to inflammation, and neurohormonal activation [ 28 ].…”

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

“…Lymphocytes were the only type of leukocytes with values outside the reference range; more precisely, below-normal levels (lymphopenia). Both leukocytosis and lymphopenia are often encountered during AECOPD episodes, when the immune response is activated due to an underlying infection or inflammation in the airways [ 32 , 33 , 34 , 35 ]. However, these immune responses alone are not specific to AECOPDs and can occur in response to various other infections and inflammatory conditions [ 6 ].…”

“…Selection bias occurs when the adjustment fails to address systematic differences between the adjusted groups, leading to biased estimates [ 51 ]. Since all biochemical analyses were performed for patients during the exacerbation periods, it is also plausible that their CBC profiles and YKL-40 levels were more deranged vs. stable periods [ 35 , 39 ]. As a result, the magnitude of changes in these parameters may be higher and hence more relevant to understanding the immunopathological connection between YKL-40 and CBC in COPD.…”