The impact of lymphopenia on delirium in ICU patients.

Inoue S, Vasilevskis EE, Pandharipande PP, Girard TD, Graves AJ, Thompson J, Shintani A, Ely EW
PLoS One. 2015 10 (5): e0126216

PMID: 25992641 · PMCID: PMC4439144 · DOI:10.1371/journal.pone.0126216

BACKGROUND - Immunosuppressed states may predispose patients to development of acute brain injury during times of critical illness. Lymphopenia is a non-specific yet commonly used bedside marker of immunosuppressed states.

METHODS - We examined whether lymphopenia would predict development of acute brain dysfunction (delirium and/or coma) in 518 patients enrolled in the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study in medical and surgical ICUs of a tertiary care, university-based medical center. Utilizing proportional odds logistic regression and Cox proportional hazards survival analysis, we assessed the relationship between pre-enrollment lymphocytes and subsequent cognitive outcomes including delirium- and coma-free days (DCFDs) and 30-day mortality.

RESULTS - There were no statistically significant associations between lymphocytes and DCFDs (p = 0.17); additionally, the relationship between lymphocytes and mortality was not statistically significant (p = 0.71). Among 259 patients without history of cancer or diabetes, there was no statistically significant association between lymphocytes and DCFDs (p = 0.07).

CONCLUSION - lymphopenia, a commonly used bedside marker of immunosuppression, does not appear to be a marker of risk for acute brain injury (delirium/coma) or 30-day mortality in general medical/surgical ICU patients.

MeSH Terms (17)

Aged Coma Critical Illness Delirium Female Humans Immunocompromised Host Intensive Care Units Logistic Models Lymphocyte Count Lymphocytes Lymphopenia Male Middle Aged Proportional Hazards Models Risk Factors Tertiary Care Centers

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