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Persistent Lymphopenia as a Poor Prognostic Factor in Patients With Multiple Organ Dysfunction Syndrome in the Renal
Xiang Xue1, Shuhua Zhu1, Shutian Xu1
1National Clinical Research Center of Kidney Disease, Nanjing Medical University, Jingling Hospital, Nanjing, China.
Purpose:
Multiple organ dysfunction syndrome (MODS), defined as two or more organ dysfunction during infection or following shock or trauma, correlates with poor outcomes. Clinical data, including MODS in the renal intensive care unit (ICU), are scarce. Therefore, we investigate the clinical characteristics and prognosis of patients with MODS in the renal ICU.
Methods:
A single-center, retrospective cohort study of 99 adult patients with MODS admitted to the renal ICU of the National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China, from October 1, 2011 to October 1, 2021.
Results:
99 patients had a mean age of 49.7 ± 16.5 years old, and 51 (51.5%) patients died within 28 days after being admitted to the renal ICU. Infection (80 patients, 80.8%) was the most common reason for admission, with 47 cases being pulmonary infections. Of all of the 99 patients, 73 (73.7%) presented with persistent lymphocytopenia (lymphocyte count < 1.1 × 109/L from the day of ICU admission through to day 7), with 33 and 40 presenting moderate (lymphocyte count 0.6-1.1 × 109/L) and severe persistent lymphopenia (lymphocyte count ≤ 0.6 × 109/L), respectively. These patients had higher illness severity and chronic kidney disease (CKD) prevalence. Patients with severe persistent lymphopenia were associated with higher 28-day ICU mortality (87.5% vs. 42.4% vs. 7.7%, p < 0.001) versus those with moderate and without persistent lymphopenia. Multivariable logistic regression analysis revealed that the number of organs involved, APACHE-II score, and persistent lymphopenia were independent risk factors for 28-day mortality in patients with MODS. The value of lymphocyte count on day 7 of admission in predicting poor prognosis of patients was higher than on other days (Area Under Curve, AUC = 0.831).
Conclusions:
Patients with MODS are critically ill with high mortality. Persistent lymphopenia is frequent in patients with MODS and is independently associated with 28-day mortality. Lymphocyte counts on day 7 of admission were shown to be highly predictive of prognosis.
Insights
Multiple organ dysfunction syndrome (MODS) in the renal ICU is linked to high mortality. Persistent lymphopenia, especially severe, significantly increases 28-day mortality risk. Lymphocyte counts on day 7 predict prognosis.
Area of Science:
- Critical Care Medicine
- Nephrology
- Immunology
Background:
- Multiple organ dysfunction syndrome (MODS) is a severe condition with high mortality.
- Clinical data on MODS specifically within the renal intensive care unit (ICU) setting is limited.
- Understanding MODS in renal ICU patients is crucial for improving outcomes.
Purpose of the Study:
- To investigate the clinical characteristics of patients with MODS admitted to a renal ICU.
- To determine the prognosis and identify risk factors for mortality in this patient population.
- To explore the association between lymphocytopenia and outcomes in renal ICU patients with MODS.
Main Methods:
- A retrospective cohort study was conducted involving 99 adult patients admitted to the renal ICU.
- Data was collected from October 1, 2011, to October 1, 2021, at a single center.
- Clinical characteristics, illness severity (APACHE-II score), and lymphocyte counts were analyzed.
Main Results:
- Infection, particularly pulmonary infections, was the primary reason for admission in 80.8% of patients.
- Persistent lymphocytopenia was observed in 73.7% of patients, with severe lymphopenia associated with significantly higher 28-day mortality (87.5%).
- Independent risk factors for 28-day mortality included the number of organs involved, APACHE-II score, and persistent lymphopenia. Lymphocyte count on day 7 showed high predictive value (AUC=0.831).
Conclusions:
- Patients with MODS in the renal ICU face critical illness and elevated mortality rates.
- Persistent lymphopenia is a common finding and an independent predictor of 28-day mortality.
- Day 7 lymphocyte counts serve as a strong prognostic indicator for patients with MODS in the renal ICU.
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