Lymphopenia is associated with poor outcomes of patients with community-acquired pneumonia and sepsis
Abstract Background Lymphopenia is a marker of poor prognosis in patients with community-acquired pneumonia (CAP), yet its impact on outcomes in patients with CAP and sepsis remains unknown. We aim to investigate the impact of lymphopenia on outcomes, risk of ICU admission and mortality in CAP patients with sepsis. Methods This was a retrospective, observational study of prospectively collected data from an 800-bed tertiary teaching hospital (2005-2019). Results Of the 2,203 patients with CAP and sepsis, 1,347 (61%) did not have lymphopenia, while 856 (39%) did. When compared to the non-lymphopenic group, patients with sepsis and lymphopenia more frequently required intensive care unit (ICU) admission (p=0.001), had a longer hospital length of stay (p˂0.001), and presented with a higher rate of in-hospital (p˂0.001) and 30-day mortality (p=0.001). Multivariable analysis showed that C-reactive protein ≥15 mg/dL, lymphopenia, pleural effusion and acute respiratory distress syndrome within 24h of admission were risk factors for ICU admission; age ≥80 years was independently associated with decreased ICU admission. In addition, age (≥80 years), chronic renal disease, chronic neurologic disease, nursing home resident, lymphopenia and pleural effusion were independently associated with increased 30-day mortality, whereas pneumococcal vaccination, diabetes mellitus and fever were independently associated with reduced 30-day mortality. Conclusions Lymphopenia was independently associated with the risk of ICU admission and higher in-hospital and 30-day mortality in patients with CAP and sepsis. Early identification of lymphopenia could help identify septic patients with CAP who require or will shortly require critical care.