Nonviral infection-related lymphocytopenia for the prediction of adult sepsis and its persistence indicates a higher mortality

Abstract

Sepsis is a life-threatening disease that affects 30 million people worldwide each year. Despite the rapid advances in medical technology and organ support systems, it is still difficult to reduce the mortality rate. Early and rapid diagnosis is crucial to improve the treatment outcome. The aim of this study was to investigate the prediction efficiency of lymphopenia and other clinical markers, such as white blood cell (WBC), neutrophil count (N#), procalcitonin (PCT), and arterial lactic acid (Lac) in the diagnosis and prognosis assessment for adult patients with nonviral infection-related sepsis. A total of 77 sepsis- and 23 non-sepsis adult patients were enrolled in this study from September 2016 to September 2018. Daily lymphocyte count (Lym) of the patients was calculated until discharge or death. The diagnostic performance of the Lym and other biomarkers were compared using the area under the receiver operating characteristic curve (ROC) value. The level of Lym was decreased significantly in the sepsis group. Lym had a high diagnostic performance for sepsis, with an area under the curve (AUC) value of 0.971 (95% CI=0.916-0.994). The diagnostic efficacy of Lym was more significant than WBC, N#, and PCT (P <0.76×109/L was 39.66%, which significantly higher than patients without persistent lymphocytopenia. Lym is a promising, low cost, fast, and easily available biomarker for the diagnosis of sepsis. When nonviral infection is suspected and lymphocytopenia level is lower than the optimal cut-off (0.76×109/L) value, high vigilance is required for sepsis. The persistence with the lymphocytopenia cut-off value (<0.76×109/L) >3 days indicates a higher 28-day mortality rate. Abbreviations: 95% CI = 95% confidence intervals, ACCP = American college of chest physicians, AIDS = acquired immune deficiency syndrome, APACHE II = Acute Physiology and Chronic Health Evaluation II, AUC = area under the curve, CAP = College of American Pathologists, ICU = intensive care unit, Lac = arterial lactic acid, Lym = lymphocyte count, N# = neutrophil count, NLCR = neutrophil-lymphocyte count ratio, NPV = negative predictive value, OR = odds ratio, PCT = procalcitonin, PDW = platelet distribution width, PPV = predictive positive value, Q1 = 1st quartile, Q3 = 3rd quartile, ROC = receiver operating characteristic curve, SCCM = the Society of Critical Care Medicine, SOFA = sequential organ failure assessment, WBC = white blood cell.