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Postoperative lymphopenia: An independent risk factor for postoperative pneumonia after lung cancer surgery, results
Guillaume Dupont1,2, Laura Flory1, Jérôme Morel1
1Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Saint-Étienne, Avenue Albert Raimond, France.
Objective:
Postoperative lymphopenia has been proposed as a risk factor for postoperative infections but has never been identified as such in a multivariate analysis. Postoperative pneumonia (POP) is one of the most common complications after lung cancer surgery and is associated with a worse outcome. We aimed to evaluate the association between postoperative lymphopenia and POP after lung cancer surgery.
Methods:
Patients admitted for lung cancer surgery (lobectomy, bilobectomy, or pneumonectomy) aged ≥ 18 years and with no history of an immunosuppressive state were eligible for inclusion. Lymphocyte counts were determined in blood drawn on the day before surgery and at postoperative days 1, 3 and 7. POP diagnosis was based on clinical, biological and radiological data. A logistic regression model adjusted on currently described risk factors for POP was used to explain the onset of this condition.
Results:
Two hundred patients were included, of whom 43 (21.5%) developed POP. Preoperative lymphocyte count was 1.8±0.6x10(9) cells/L and 2.0±0.7x10(9) cells/L in patients with and without POP, respectively (P = .091). In both groups, the lymphocyte count nadir occurred at postoperative day 1. In multivariate analysis, lymphopenia at postoperative day 1 was significantly associated with increased risk of POP (odds ratio: 2.63, 95% CI [1.03-5.40]). POP rate at postoperative day 7 was higher in patients presenting low lymphocyte counts (≤1.19x10(9) cells/L) at postoperative day 1 (P = .003).
Conclusions:
Our study showed that lymphopenia following lung cancer surgery was maximal at postoperative day 1 and was associated with POP.
Insights
Postoperative lymphopenia, a low lymphocyte count after surgery, is linked to a higher risk of postoperative pneumonia (POP) in lung cancer patients. This association was strongest on postoperative day 1.
Area of Science:
- Thoracic Surgery
- Oncology
- Immunology
Background:
- Postoperative infections are a concern after lung cancer surgery.
- Postoperative pneumonia (POP) is a common complication impacting patient outcomes.
- Lymphopenia, a low lymphocyte count, is a potential but unconfirmed risk factor for infections.
Purpose of the Study:
- To investigate the association between postoperative lymphopenia and the development of POP after lung cancer surgery.
- To determine if lymphopenia is an independent risk factor for POP in this patient population.
Main Methods:
- A cohort of 200 patients undergoing lung cancer surgery (lobectomy, bilobectomy, or pneumonectomy) was studied.
- Lymphocyte counts were measured preoperatively and on postoperative days 1, 3, and 7.
- Logistic regression analysis was employed to assess the relationship between lymphopenia and POP, adjusting for known risk factors.
Main Results:
- Of 200 patients, 43 (21.5%) developed POP.
- Lymphopenia on postoperative day 1 was significantly associated with an increased risk of POP (OR: 2.63).
- Patients with low lymphocyte counts (≤1.19x10^9 cells/L) on postoperative day 1 had a higher POP rate by day 7.
Conclusions:
- Postoperative lymphopenia, particularly on day 1 after surgery, is associated with an increased risk of POP in lung cancer patients.
- The nadir of lymphocyte count typically occurs on postoperative day 1.
- These findings suggest lymphopenia may serve as a predictive marker for POP.
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