Objective To determine whether persistent lymphopenia on the fourth day following the diagnosis of sepsis predicts mortality. Methods Single-center, retrospective cohort study of 335 adult patients with bacteremia and sepsis admitted to a large university-affiliated tertiary care hospital between January 1, 2010 and July 31, 2012. All complete blood cell count profiles during the first four days following the diagnosis of sepsis were recorded. The primary outcome was 28-day mortality. Secondary outcomes included development of secondary infections, 1-year mortality, and hospital and intensive care unit lengths of stay. Results 76 (22.7%) patients died within 28 days. Lymphopenia was present in 28-day survivors (median 0.7 cells/μl × 103 [IQR 0.4, 1.1]) and non-survivors (median 0.6 cells/μl × 103 [IQR 0.4, 1.1]) at the onset of sepsis and was not significantly different between the groups (p = .35). By Day 4, the median absolute lymphocyte count was significantly higher in survivors compared to non-survivors (1.1 cells/μl × 103 [IQR 0.7, 1.5] vs 0.7 cells/μl × 103 [IQR 0.5, 1.0], p < .0001). Using logistic regression to account for potentially confounding factors (including age, APACHEII score, comorbidities, surgical procedure during the study period, and time until appropriate antibiotic administration), day 4 absolute lymphocyte count was found to be independently associated with 28-day survival (adjusted OR 0.68 [95% CI 0.51, 0.91]) and 1-year survival (adjusted OR 0.74 [95% CI 0.59, 0.93]). Severe persistent lymphopenia (defined as an absolute lymphocyte count ≤ 0.6 cells/μL × 103 on the fourth day after sepsis diagnosis) was associated with increased development of secondary infections (p = .04). Conclusions Persistent lymphopenia on the fourth day following the diagnosis of sepsis predicts early and late mortality and may serve as a biomarker for sepsis-induced immunosuppression.

In ARDS, inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures and may be associated with harm. Data are limited both in terms of methodologic quality and demonstration of clinical benefit. The use of inhaled prostaglandins in ARDS needs further study.

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There is poor agreement between clinical and administrative surveillance methods for the diagnosis of ventilator-associated pneumonia. Although there may be some benefit to using more stringent criteria for surveillance of ventilator-associated pneumonia, use of the administratively applied National Healthcare Safety Network criteria may significantly underestimate the scope of the clinical problem.