Influencia de la linfopenia en la mortalidad a largo plazo en shock séptico, estudio observacional retrospectivo

Abstract

Background and objective

The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%-50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.

Patients and methods

Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).

Results

A total of 74.1% of patients showed lymphopenia, and 66.3% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. A leukocyte count < 12,000 /μL was a predictor of early mortality (OR: 2.96) and LRec of late mortality (OR: 3.98). Long-term mortality was associated with LRec (HR: 1.69).

Conclusions

In elderly patients with septic shock, the absence of leukocytosis and neutrophilia is associated with 28-day mortality, and LRec with 2-year mortality; this may represent two distinct phenotypes of behaviour after septic shock.