Persistent lymphopenia in septic patients at Dr. Sardjito General Hospital, Yogyakarta

https://doi.org/10.19106/JMedSci005204202003

Doni Priambodo(1), Rizka Humardewayanti Asdie(2), Yanri Wijayanti Subronto(3), Juvita Kurniawan(4*)

(1) Division of Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta
(2) Division of Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta
(3) Division of Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta
(4) Resident of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr. Sardjito General Hospital, Yogyakarta
(*) Corresponding Author

Abstract


Sepsis triggers immune responseboth pro-inflammatory and anti-inflammatory. Lymphocytes play an important role in the regulation of the inflammatory response. The decrease in lymphocyte numbers due to continuous apoptosis by sepsiscan suppress the immune system and failure to resolve inflammation. Persistent lymphopenia is also associated with a poor prognosis of sepsis. Currently, there are limited studies about persistent lymphopenia in sepsis patients in low- and middle-income countries, including Indonesia. This study aimed to describe the sociodemographic, clinical, and laboratory patterns of sepsis patients with persistent lymphopenia. This was a descriptive study that analyzed patients’ medical records who were treated at the Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta from January 1st, 2016, to December 31th, 2017. Patients diagnosed with clinical sepsis and persistent lymphopenia were included in the study. The status of persistent lymphopenia was described as lymphocyte counts that remained low or lower (<1.62x103/L) on day 4± 24 h compared to the initial value at the time of sepsis diagnosis (day one). Information of patients’ individual and clinical characteristics, complete blood cell count profiles and culture results were included. The outcomes of interest were the survival status and length of stay of the patients. A total of 101 patients with sepsis and persistent lymphopenia were involved in this study. The average increase in lymphocyte numbers was 73.63 ± 426.86/µL. The main source of infection was pulmonary infection, with a mortality rate of 43.6% and a median survival of 19 days. The average length of stay was 13.1±6.8. Persistent lymphopenia in patients with sepsis has a high mortality. Further research is needed to determine the clinical ramifications of persistent lymphopenia.


Keywords


Persistent Lymphopenia; Sepsis

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References

  1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013; 369(9):840-51. https://doi.org/10.1056/NEJMra1208623
  2. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediators Inflamm 2016; 2016:8191254. https://doi.org/10.1155/2016/8191254
  3. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care2010; 14(5):192. https://doi.org/10.1186/cc9309
  4. Inoue S, Utsunomiya KS, Okada Y, Taira T, Iida Y, Miura N, et al. Reduction of immunocompetent T cells followed by prolonged lymphopenia in severe sepsis in the elderly. Crit Care Med 2013; 41(3):810-9. https://doi.org/10.1097/CCM.0b013e318274645f
  5. Drewry AM, Samra N, Skrupky LP, Fuller BM, Compton SM, Hotchkiss RS. Persistent Lymphopenia after diagnosis of sepsis predicts mortality. Shock 2014; 42(5):383-91. https://doi.org/10.1097/SHK.0000000000000234
  6. Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 2016; 193:259-72. https://doi.org/10.1164/rccm.201504-0781OC
  7. Gauer RL. Early recognition and management of sepsis in adults: the first six hours. Am Fam Physician 2013; 88(1):44-53.
  8. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med 2012; 7(Suppl 3):S193-9. https://doi.org/10.1007/s11739-012-0802-0
  9. Blume J, Douglas SD, Evans DL. Immune suppression and immune activation in depression. Brain Vehav Immun 2011; 25(2):221-9. https://doi.org/10.1016/j.bbi.2010.10.008
  10. Provan D, Singer CRJ, Baglin T, Lilleyman J. Oxford handbook of clinical haematology,2nd ed. Oxford: Oxford University Press, 2004; pp 16-19.
  11. Mazzone A, Dentali F, Regina ML, Foglia E, Gambarcota M, Garagiola E, et al. Clinical features, short-term mortality, and prognostic risk factors of septic patients admitted to internal medicine units. Medicine 2016; 95(4):2124. https://doi.org/10.1097/MD.0000000000002124
  12. Wang HE, Shapiro NI, Griffin R, Safford MM, Judd S, Howard G. Chronic medical conditions and risk of sepsis. PLoS One 2012; 7(10):e48307. https://doi.org/10.1371/journal.pone.0048307
  13. Asdie RH, Octavianto RA, Pasaribu FZ, Wirawan AD, Murti WW, Suharyanto, et al. In: Nirwati H, Annisa L, editors. Kultur darah, skor SOFA, dan SAPS II untuk memprediksi tingkat keparahan dan kematian akibat Sepsis. Proceedings of Annual Scientific Meeting (ASM) Pokja Mikrobiologi; 2017 April 07; Yogyakarta: Departemen Mikrobiologi, Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta.
  14. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet 2005; 365(9453):63-78. https://doi.org/10.1016/S0140-6736(04)17667-8
  15. Chung KP, Chang HT, Lo SC, Chang LY, Lin SY, Cheng A, et al. Severe lymphopenia is associated with elevated plasma interleukin-15 levels and increased mortality during severe sepsis. Shock 2015; 43(6):569-75. https://doi.org/10.1097/SHK.0000000000000347
  16. Hutchins NA, Usinger J, Hotchkiss RS, Ayala A. The new normal: immunomodulatory agents against sepsis immune suppression. Trends Mol Med 2014; 20(4):224-33. https://doi.org/10.1016/j.molmed.2014.01.002



DOI: https://doi.org/10.19106/JMedSci005204202003

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