Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study).

IF 4.2 2区医学 Q1 ANESTHESIOLOGY

European Journal of Anaesthesiology Pub Date : 2024-10-30 DOI:10.1097/EJA.0000000000002089

Ludivine Petit, Bruno Pastene, Guillaume Dupont, Bruno Baffeleuf, Pierre-Alain Goulevant, Jean-Luc Fellahi, Yann Gricourt, Gilles Lebuffe, Alexandre Ouattara, Marc-Olivier Fischer, Paul-Michel Mertes, Daniel Eyraud, Belaid Bouhemad, Alexandra Gomola, Philippe Montravers, Julie Alingrin, Laura Flory, Pascal Incagnoli, Matthieu Boisson, Marc Leone, Guillaume Monneret, Anne Claire Lukaszewicz, Bruno Pereira, Serge Molliex

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引用次数: 0

Abstract

Background: Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).

Objectives: We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence.

Study design: The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia.

Setting: Patients were included from January 2016 to September 2017 in 25 French centres.

Patients: Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.

Main outcome measure: PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).

Results: Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time (P = 0.001) but not with preoperative LC (P = 0.536).POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors.

Conclusions: POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account.

Trial registration: ClinicalTrials.gov Identifier: NCT02799251.

查看原文本刊更多论文

术后淋巴细胞减少症是癌症手术术后感染的风险因素：前瞻性多中心队列研究（EVALYMPH 研究）。

背景：手术创伤导致的应激会降低术后淋巴细胞计数（LCs），从而可能导致术后感染（PIs）的发生：我们旨在确定胸腔或胃肠道癌症手术后淋巴细胞减少症是否是 PIs 的独立风险因素，并找出可能影响其发生的麻醉和手术过程的可调节因素：EVALYMPH研究是一项前瞻性多中心队列研究，对患者进行为期30天的随访。研究进行了多变量分析，以确定PIs和术后淋巴细胞减少症的风险因素：2016年1月至2017年9月期间，25家法国中心纳入了患者：患者：接受胸部或胃肠道癌症手术的成人患者：术后30天内的PI定义为尿路感染、肺炎、手术部位感染和其他感染（血流感染或胸膜炎）：在纳入的 1207 名患者中，有 273 人（22.6%）在术后 30 天内至少发生了一次感染，感染发生的中位数[IQR]时间为 8 [5-11] 天。PI风险的增加与ASA评分为IV显著相关：危险比（HR）为4.27（95%置信区间（CI）为1.87至9.72），手术时间大于200分钟（HR为1.58（1.15至2.17）），术后第1天（POD1）出现淋巴细胞减少（HR为1.56（1.08至2.25））。POD1淋巴细胞减少症与患者特征和手术持续时间有关，但与其他手术或麻醉因素无关：POD1淋巴细胞减少症与胸腔或胃肠道癌症手术患者的PIs有关。为实现个体化治疗，应考虑患者特征和手术持续时间：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT02799251。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).