Persistent Lymphopenia as a Poor Prognostic Factor in Patients With Multiple Organ Dysfunction Syndrome in the Renal Intensive Care Unit: A Retrospective Single-Center Study

IF 3.1 4区医学 Q3 IMMUNOLOGY

Immunity, Inflammation and Disease Pub Date : 2025-02-14 DOI:10.1002/iid3.70152

Xiang Xue, Shuhua Zhu, Shutian Xu, Yuchao Zhou, Yang Wang, Lixuan Lou, Shijun Li

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Abstract

Purpose

Multiple organ dysfunction syndrome (MODS), defined as two or more organ dysfunction during infection or following shock or trauma, correlates with poor outcomes. Clinical data, including MODS in the renal intensive care unit (ICU), are scarce. Therefore, we investigate the clinical characteristics and prognosis of patients with MODS in the renal ICU.

Methods

A single-center, retrospective cohort study of 99 adult patients with MODS admitted to the renal ICU of the National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China, from October 1, 2011 to October 1, 2021.

Results

99 patients had a mean age of 49.7 ± 16.5 years old, and 51 (51.5%) patients died within 28 days after being admitted to the renal ICU. Infection (80 patients, 80.8%) was the most common reason for admission, with 47 cases being pulmonary infections. Of all of the 99 patients, 73 (73.7%) presented with persistent lymphocytopenia (lymphocyte count < 1.1 × 10⁹/L from the day of ICU admission through to day 7), with 33 and 40 presenting moderate (lymphocyte count 0.6–1.1 × 10⁹/L) and severe persistent lymphopenia (lymphocyte count ≤ 0.6 × 10⁹/L), respectively. These patients had higher illness severity and chronic kidney disease (CKD) prevalence. Patients with severe persistent lymphopenia were associated with higher 28-day ICU mortality (87.5% vs. 42.4% vs. 7.7%, p < 0.001) versus those with moderate and without persistent lymphopenia. Multivariable logistic regression analysis revealed that the number of organs involved, APACHE-II score, and persistent lymphopenia were independent risk factors for 28-day mortality in patients with MODS. The value of lymphocyte count on day 7 of admission in predicting poor prognosis of patients was higher than on other days (Area Under Curve, AUC = 0.831).

Conclusions

Patients with MODS are critically ill with high mortality. Persistent lymphopenia is frequent in patients with MODS and is independently associated with 28-day mortality. Lymphocyte counts on day 7 of admission were shown to be highly predictive of prognosis.

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持续性淋巴细胞减少是肾重症监护病房多器官功能障碍综合征患者预后不良的因素：一项回顾性单中心研究

多器官功能障碍综合征（MODS）被定义为感染期间或休克或创伤后的两个或多个器官功能障碍，与不良预后相关。临床资料，包括肾脏重症监护病房（ICU）的MODS，是稀缺的。因此，我们探讨MODS患者在肾脏ICU的临床特点和预后。方法对2011年10月1日至2021年10月1日在中国南京金陵医院国家肾脏疾病临床研究中心肾科ICU收治的99例MODS成人患者进行单中心、回顾性队列研究。结果99例患者平均年龄（49.7±16.5）岁，51例（51.5%）患者在入肾ICU后28 d内死亡。感染是最常见的入院原因（80例，80.8%），其中肺部感染47例。99例患者中，73例（73.7%）出现持续性淋巴细胞减少（从入院至第7天淋巴细胞计数1.1 × 109/L），中度（淋巴细胞计数0.6 ~ 1.1 × 109/L） 33例，重度（淋巴细胞计数≤0.6 × 109/L） 40例。这些患者有较高的疾病严重程度和慢性肾脏疾病（CKD）患病率。与中度和非持续性淋巴细胞减少患者相比，严重持续性淋巴细胞减少患者28天ICU死亡率更高（87.5% vs. 42.4% vs. 7.7%, p < 0.001）。多变量logistic回归分析显示，受损伤器官数量、APACHE-II评分和持续性淋巴细胞减少是MODS患者28天死亡率的独立危险因素。入院第7天淋巴细胞计数对患者预后不良的预测价值高于其他天数（曲线下面积，AUC = 0.831）。结论MODS患者病情危重，病死率高。持续淋巴细胞减少症在MODS患者中很常见，并且与28天死亡率独立相关。入院第7天的淋巴细胞计数可高度预测预后。

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来源期刊

Immunity, Inflammation and Disease Medicine-Immunology and Allergy

CiteScore

3.60

自引率

0.00%

发文量

146

审稿时长

8 weeks

期刊介绍： Immunity, Inflammation and Disease is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research across the broad field of immunology. Immunity, Inflammation and Disease gives rapid consideration to papers in all areas of clinical and basic research. The journal is indexed in Medline and the Science Citation Index Expanded (part of Web of Science), among others. It welcomes original work that enhances the understanding of immunology in areas including: • cellular and molecular immunology • clinical immunology • allergy • immunochemistry • immunogenetics • immune signalling • immune development • imaging • mathematical modelling • autoimmunity • transplantation immunology • cancer immunology