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
{"title":"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）。","authors":"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","doi":"10.1097/EJA.0000000000002089","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).</p><p><strong>Objectives: </strong>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.</p><p><strong>Study design: </strong>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.</p><p><strong>Setting: </strong>Patients were included from January 2016 to September 2017 in 25 French centres.</p><p><strong>Patients: </strong>Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.</p><p><strong>Main outcome measure: </strong>PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02799251.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study).\",\"authors\":\"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\",\"doi\":\"10.1097/EJA.0000000000002089\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).</p><p><strong>Objectives: </strong>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.</p><p><strong>Study design: </strong>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.</p><p><strong>Setting: </strong>Patients were included from January 2016 to September 2017 in 25 French centres.</p><p><strong>Patients: </strong>Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.</p><p><strong>Main outcome measure: </strong>PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02799251.</p>\",\"PeriodicalId\":11920,\"journal\":{\"name\":\"European Journal of Anaesthesiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Anaesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EJA.0000000000002089\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Anaesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EJA.0000000000002089","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study).
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.
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).
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