• Adrian Ceccato, Meropi Panagiotarakou, Otavio T Ranzani, Marta Martin-Fernandez, Raquel Almansa-Mora, Albert Gabarrus, Leticia Bueno, Catia Cilloniz, Adamantia Liapikou, Miquel Ferrer, Jesus F Bermejo-Martin, and Antoni Torres.
• Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain. aceccato@clinic.cat.
• J Clin Med. 2019 Jun 13; 8 (6).

BackgroundIntensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP.MethodsProspective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016).ResultsOf the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94).ConclusionLymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.

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