Objective

Growing evidence suggests that lymphocytopenia on admission (LOA) is associated with infectious complications and poor outcomes in intracerebral hemorrhage (ICH). Whether LOA preferentially increases the risk for community acquired infections or nosocomial infections is unknown. This study investigates the relationship between LOA and nosocomial infections in a cohort of patients with ICH in a safety-net hospital.

Material and methods

This is a single center, observational, retrospective study of 213 patients with non-traumatic ICH admitted to the neurocritical care unit between 2008 and 2014. Patients’ clinical, demographic, lab and radiologic data were retrieved from institutional electronic medical records. Nosocomial infection was defined as clinical onset 48 h after admission.

Results

Prevalence of LOA was 24.8%. Patients with LOA showed significant associations with mechanical ventilation (67.9% versus 49.4%; p= 0.019), higher median ICH score (2 versus 1; p=0.006), nosocomial infection (43.4% versus 28.0%; p=0.038), nosocomial UTI (24.5% versus 8.9%; p=0.003). Adjusting for baseline covariates in a multivariate logistic regression, we observed an association of LOA with nosocomial UTI (OR, 3.66 [95% CI, 1.36-9.88], p=0.010). From the Cox proportional model, patients with LOA had 1.76 times the hazard of developing of nosocomial infection, compared to those without LOA ([95% CI: 1.01, 3.07], p=0.046) and had 3.27 times the hazard of developing nosocomial UTI, compared to those without LOA ([95% CI: 1.39, 7.67], p=0.007).

Conclusions

This study is the first to show that LOA is associated with nosocomial urinary tract infections and significantly shorter times to develop nosocomial infections.

中文翻译：

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入院 淋巴细胞减少与出血性中风的尿路感染和医院感染有关

客观的

越来越多的证据表明，入院时淋巴细胞减少症 (LOA) 与感染性并发症和脑出血 (ICH) 预后不良有关。LOA 是否优先增加社区获得性感染或医院感染的风险尚不清楚。本研究调查了一家安全网医院 ICH 患者队列中 LOA 与医院感染之间的关系。

材料与方法

这是一项单中心、观察性、回顾性研究，对 2008 年至 2014 年间入住神经重症监护病房的 213 名非创伤性 ICH 患者进行了研究。从机构电子病历中检索了患者的临床、人口统计、实验室和放射学数据。院内感染定义为入院后 48 小时临床发病。

结果

LOA 的患病率为 24.8%。LOA 患者与机械通气（67.9% 对 49.4%；p=0.019）、较高的中位 ICH 评分（2 对 1；p=0.006）、医院感染（43.4% 对 28.0%；p=0.038）、医院感染显着相关。尿路感染（24.5% 对 8.9%；p=0.003）。在多变量逻辑回归中调整基线协变量，我们观察到 LOA 与医院 UTI 的关联（OR，3.66 [95% CI，1.36-9.88]，p=0.010）。根据 Cox 比例模型，与没有 LOA 的患者相比，患有 LOA 的患者发生院内感染的风险是其 1.76 倍（[95% CI：1.01, 3.07]，p=0.046），发生院内 UTI 的风险是其 3.27 倍，与没有 LOA 的人相比 ([95% CI: 1.39, 7.67], p=0.007)。

结论

这项研究首次表明 LOA 与医院尿路感染有关，并且显着缩短了发生医院感染的时间。