Preoperative lymphopaenia, mortality, and morbidity after elective surgery: systematic review and meta-analysis

Abstract

Background: In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis. Methods: We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0e1.5Â10 9 L À1 . Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the NewcastleeOttawa Scale. The I 2 index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days. Results: Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46e91 yr; female, 20e79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the NewcastleeOttawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]¼3.22; 95% confidence interval [CI], 2.19e4.72; P<0.01, I 2 ¼0%) and more frequent major postoperative complications (RR¼1.33; 95% CI, 1.21e1.45; P<0.01, I 2 ¼6%), including cardiovascular morbidity (RR¼1.77; 95% CI, 1.45e2.15; P<0.01, I 2 ¼0%), infections (RR¼1.45; 95% CI, 1.19e1.76; P<0.01, I 2 ¼0%), and acute renal dysfunction (RR¼2.66; 95% CI, 1.49e4.77; P<0.01, I 2 ¼1%). Conclusion: Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery. Prospero registry number: CRD42020190702.

Can C-reactive protein based biomarkers be used to predictive of 30-day mortality in elderly hip fractures?: A retrospective study

“…[6] Pre-operative lymphopenia is associated with a higher incidence of post-operative complications such as cardiac, infectious, and renal failure. [7] In the general population, lymphopenia is also associated with an increased risk of hospitalization for infection. [7] The level of albumin in serum is considered an indicator of nutritional status.…”

“…[7] In the general population, lymphopenia is also associated with an increased risk of hospitalization for infection. [7] The level of albumin in serum is considered an indicator of nutritional status. Albumin that is a negatively charged substance synthesized by the liver is an acute-phase reactant.…”

Pooled prevalence of lymphopenia in all-cause hospitalisations and association with infection: a systematic review and meta-analysis

“…Lymphopenia has been associated with increased mortality and infection risk in a wide range of settings including community populations, perioperative, and sepsis [ 15 , 18 , 19 , 45 ]. The studies have broadly shown that lymphopenia is associated with an increased risk of infections and mortality.…”

“…Our findings are broadly in line with other studies. In a meta-analysis of peri-operative patients, lymphopenia was associated with a three-fold increase in mortality and a higher rate of postoperative complications and infections [ 45 ]. While we demonstrated increased mortality in both ‘early’ and ‘late’ deaths, we did not demonstrate an increase in risk of infection.…”

Association of lymphopenia and RDW elevation with risk of mortality in acute aortic dissection

“…It is generally believed that lymphopenia is one of the typical phenotypes of immune dysregulation and is among the strongest risk factors for outcomes in cardiovascular and noncardiovascular disorders [16][17][18][19][20][21]. However, the relationship between lymphopenia and AAD mortality has rarely been studied.…”