Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality |
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| Affiliation: | 1. Servicio de Neumología, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain;2. PhD program in Medicine and Translational Research, University of Barcelona, Barcelona, Spain;3. Center for Biomedical Research Network in Respiratory Diseases (CIBERES, CB06/06/0028), Madrid, Spain;4. Intensive Care Unit, Hospital Universitario y Politécnico La Fe / IIS La Fe, Valencia, Spain;5. Hematology Department, Hematology Research Group, Hospital Universitario y Politécnico La Fe / IIS La Fe, Valencia, Spain;6. Center for Biomedical Research Network in Cancer (CIBERONC), Madrid, Spain;7. Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario de Valladolid / Instituto de Estudios de Ciencias de la Salud de Castilla Y León (IECSCYL), Valladolid, Spain;8. Pneumology Department, Hospital Clínic / Institut D''Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain;1. Guangdong Provincial Center for Disease Control and Prevention, No. 160, Qunxian Road, Panyu District, Guangzhou, Guangdong, China;2. Guangdong Provincial Institution of Public Health, No. 160, Qunxian Road, Panyu District, Guangzhou, Guangdong, China;3. Southern Medical University, No. 1838, Shatai Road, Baiyun District, Guangzhou, People''s Republic of China;4. Zhaoqing Center for Disease Control and Prevention, No. 6 Xincheng Northern Road, Ruicheng district, Zhaoqing City, Guangdong, China;1. Clinical Microbiology, University Hospitals of Leicester NHS Trust, Level 5 Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK;2. Infectious Diseases Unit, University Hospitals of Leicester NHS Trust, Leicester, UK;3. Department of Respiratory Sciences, University of Leicester, Leicester, UK;4. Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands;1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland;2. Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland;3. Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland;4. Zentrallabour Zurich, Zurich, Switzerland;1. National and Regional Joint Engineering Laboratory for Medicament of Zoonoses Prevention and Control, College of Veterinary Medicine, South China Agricultural University, China;2. Experimental Animal Center, South China Agricultural University, Guangzhou, China;3. Key Laboratory of Zoonoses, Key Laboratory of Animal Vaccine Development, Ministry of Agriculture, Guangzhou, China;4. Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, China;5. Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA;1. Center for Disease Control and Prevention of Chinese People''s Liberation Army, 20 Dongdajie Street, Fengtai District, Beijing 100071, China;2. 305 Hospital of PLA, A13 Wenjin Street, Xicheng District, Beijing, 10017, China;3. State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Science, 20 Dongdajie Street, Fengtai District, Beijing 100071, China;1. Infectious Diseases, All India Institute of Medical Sciences, New Delhi, India;2. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India;3. Taluk Hospital, Balussery, Kozhikode, Kerala, India;4. Department of Health and Family Welfare, Government of Kerala, India |
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| Abstract: | ObjectivesLymphopenic (<724 lymphocytes/µL) community-acquired pneumonia (L-CAP) is an immunophenotype with an increased risk of mortality. We aimed to characterize the l-CAP immunophenotype though lymphocyte subsets and the inflammatory response and its relationship with severity at presentation and outcome.MethodsProspective study of 217 immunocompetent patients hospitalized for CAP. Lymphocyte subsets (CD4+, CD8+, CD19+, and natural killer [NK] cells) and inflammatory cytokines were analyzed on days 1 and 4, and immunoglobulin subclasses were analyzed on day 1 in a nested group.Results39% of patients showed l-CAP, with decreased levels of all lymphocyte subsets with a partial recovery of CD4+ and CD8+ cells by day 4. l-CAP patients exhibited higher initial severity and systemic levels of interleukin (IL)-8, IL-10, granulocyte colony-stimulating factor, and monocyte chemoattractant protein-1. Initial IgG2 levels were lower in patients with <724 lymphocytes/µL and positively correlated with ALC, CD4+, and CD19+ cell counts. Low CD4+ counts (<129 cells/µL) also independently predicted 30-day mortality after adjusting for age, gender, and the CURB-65 score.Conclusionsl-CAP is characterized by CD4+ depletion, a higher inflammatory response, and low IgG2 levels that correlated with greater severity at presentation and worse prognosis. l-CAP is an immunophenotype useful for rapidly recognizing severity. |
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