Early Lymphopenia and Infections in Nontraumatic Subarachnoid Hemorrhage Patients

Abstract

Introduction: Subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. A certain degree of immunodepression has been reported during critical illness, and lymphopenia identified as an independent predictor of poor outcome; no data are available for critically ill SAH patients. We aimed to evaluate the prevalence of lymphopenia among SAH patients and its association with hospital-acquired infection.Methods: Retrospective cohort study of adult patients admitted to an intensive care unit with nontraumatic SAH between January 2011 and May 2016. Lymphocyte count was obtained daily for the first 5 days; lymphopenia was defined as lymphocyte count <1000/mm 3 . The occurrence of infection during the first 21 days after hospital admission, hospital mortality, and unfavorable neurological outcome (Glasgow Outcome Scale score 1 to 3 at 3 mo) were recorded.Results: Data from 270 patients were analyzed (median age 54 y; male 45%); 121 (45%) patients had lymphopenia and 62 (23%) patients developed infections. Median (25th to 75th percentiles) lymphocyte count at hospital admission was 1280 (890 to 1977)/mm 3 . Lymphopenia patients had more episodes of infection (38/121, 31% vs. 24/139, 17%; P = 0.003) than nonlymphopenia patients, while mortality and unfavorable outcome were similar. Lymphopenia was not independently associated with the development of infection, unfavorable neurological outcome or with mortality.Conclusions: Early lymphopenia is common after SAH, but is not significantly associated with the development of infections or with poor outcome.

Systemic Immune-Inflammation Index Predicts Delayed Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

“…[29][30][31] Decreased serum lymphocytes plays a role in infectious complications of aSAH, although the association with vasospasm is unclear. 31,32 Elevated NLR independently predicts DND and functional outcome, although predictive ability for vasospasm has not been fully established. 14,33,34 Further, evidence supports the role of platelet activation in driving poor outcomes after aSAH.…”

Systemic Inflammation after Aneurysmal Subarachnoid Hemorrhage

“…It was reported that 15.8–41% of CNS injury patients contracted nosocomial infections during hospitalization [ 20 , 21 , 22 , 23 ]. Increased infection risk (31% vs. 17%) was observed among patients with non-traumatic SAH, with lymphopenia reported among 45% of the patients [ 24 ]. The inflammatory cytokine surge may contribute to the immunosuppressed state [ 25 , 26 ] after aSAH by promoting the secretion of corticotropin-releasing hormone (CRH) from the hypothalamic paraventricular nucleus (PVN) [ 27 , 28 , 29 , 30 ].…”

Lymphocyte trajectories are associated with prognosis in critically ill patients: A convenient way to monitor immune status

“…According to a large retrospective cohort study, lymphopenia increases the risk of infection and infectionrelated death in the general population (6). In patients with sepsis, lymphopenia is associated with increased mortality, and dynamic lymphocyte decline is also associated with poor prognosis (7)(8)(9)(10). Nevertheless, due to the heterogeneity of critically ill patients, there are also differences in ALC; for example, ALC at admission to ICU is lower in elderly patients than in non-elderly patients (11).…”