Kelsey Koch1, Alexander M Troester2, Phani T Chevuru2, Brady Campbell2, Colette Galet1, Patrick W McGonagill3. 1. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa. 2. Carver College of Medicine, University of Iowa, Iowa City, Iowa. 3. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: patrick-mcgonagill@uiowa.edu.
Abstract
BACKGROUND: Lymphopenia contributes to the immune suppression observed in critical illness. However, its role in the immunologic response to trauma remains unclear. Herein, we assessed whether admission lymphopenia is associated with poor outcomes in patients with blunt chest wall trauma (BCWT). METHODS: All adult patients with a Chest Abbreviated Injury Score (CAIS) ≥2 admitted to our Level I Trauma center between May 2009 and December 2018 were identified in our institution Trauma Registry. Patients with absolute lymphocyte counts (ALC) collected within 24 H of admission were included. Patients who died within 24 H of admission, had bowel perforation on admission, penetrating trauma, and burns were excluded. Demographics, injury characteristics, comorbidities, ALC, complications, and outcomes were collected. Lymphopenia was defined as an ALC ≤1000/µL. Association between lymphopenia and clinical outcomes of BCWT was assessed using multivariate analyses. P < 0.05 was considered significant. RESULTS: A total of 1394 patients were included; 69.7% were male; 44.3% were lymphopenic. On univariate analysis, lymphopenia was associated with longer in-hospital stay (11.6±10.2 versus 10.1±11.4, P = 0.009), in-hospital death (9.7% versus 5.8%, P = 0.006), and discharge to a healthcare facility (60.9% versus 46.4%, P < 0.001). Controlling for Injury Severity Score, age, gender, and comorbidities, the association between lymphopenia and discharge to another facility (SNF/rehabilitation facility/ACH) (OR = 1.380 [1.041-1.830], P = 0.025) remained significant. CONCLUSIONS: Lymphopenia on admission is associated with discharge requiring increased healthcare support. Routine lymphocyte count monitoring on admission may provide important prognostic information for BCWT patients.
BACKGROUND: Lymphopenia contributes to the immune suppression observed in critical illness. However, its role in the immunologic response to trauma remains unclear. Herein, we assessed whether admission lymphopenia is associated with poor outcomes in patients with blunt chest wall trauma (BCWT). METHODS: All adult patients with a Chest Abbreviated Injury Score (CAIS) ≥2 admitted to our Level I Trauma center between May 2009 and December 2018 were identified in our institution Trauma Registry. Patients with absolute lymphocyte counts (ALC) collected within 24 H of admission were included. Patients who died within 24 H of admission, had bowel perforation on admission, penetrating trauma, and burns were excluded. Demographics, injury characteristics, comorbidities, ALC, complications, and outcomes were collected. Lymphopenia was defined as an ALC ≤1000/µL. Association between lymphopenia and clinical outcomes of BCWT was assessed using multivariate analyses. P < 0.05 was considered significant. RESULTS: A total of 1394 patients were included; 69.7% were male; 44.3% were lymphopenic. On univariate analysis, lymphopenia was associated with longer in-hospital stay (11.6±10.2 versus 10.1±11.4, P = 0.009), in-hospital death (9.7% versus 5.8%, P = 0.006), and discharge to a healthcare facility (60.9% versus 46.4%, P < 0.001). Controlling for Injury Severity Score, age, gender, and comorbidities, the association between lymphopenia and discharge to another facility (SNF/rehabilitation facility/ACH) (OR = 1.380 [1.041-1.830], P = 0.025) remained significant. CONCLUSIONS: Lymphopenia on admission is associated with discharge requiring increased healthcare support. Routine lymphocyte count monitoring on admission may provide important prognostic information for BCWT patients.
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: Epidemiology Date: 2007-11 Impact factor: 4.822
Authors: Rodney M Ritzel; Sarah J Doran; James P Barrett; Rebecca J Henry; Elise L Ma; Alan I Faden; David J Loane Journal: J Neurotrauma Date: 2018-05-03 Impact factor: 5.269
Authors: Andrea Morotti; Sandro Marini; Michael J Jessel; Kristin Schwab; Christina Kourkoulis; Alison M Ayres; M Edip Gurol; Anand Viswanathan; Steven M Greenberg; Christopher D Anderson; Joshua N Goldstein; Jonathan Rosand Journal: Neurocrit Care Date: 2017-04 Impact factor: 3.210
Authors: Joanna Manson; Elaine Cole; Henry D De'Ath; Paul Vulliamy; Ute Meier; Dan Pennington; Karim Brohi Journal: Crit Care Date: 2016-06-07 Impact factor: 9.097
Authors: A J L M Geraerds; Juanita A Haagsma; L de Munter; N Kruithof; M de Jongh; Suzanne Polinder Journal: PLoS One Date: 2019-12-30 Impact factor: 3.240