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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (3): 552-556. doi: 10.19723/j.issn.1671-167X.2022.03.023

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Early changes within the lymphocyte population are associated with the long term prognosis in severely injured patients

Fu-zheng GUO,Xiu-juan ZHAO,Jiu-xu DENG,Zhe DU,Tian-bing WANG,Feng-xue ZHU*()   

  1. Trauma Medicine Center, Peking University People′s Hospital, Bejing 10044, China
  • Received:2020-07-15 Online:2022-06-18 Published:2022-06-14
  • Contact: Feng-xue ZHU E-mail:fxzhu72@163.com
  • Supported by:
    the Capital Health Research and Development of Special(首发2018-2-408)

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Abstract:

Objective: To investigate the relationship between early lymphocyte responses and the prognosis in severely injured patients. Methods: Consecutive patients with severe trauma who were treated in Peking University People′s Hospital Trauma Medical Center between June 2017 and June 2020 were enrolled in this restropective chart-review study. According to the responses of lymphocyte after severe injury, the patients were divided into three groups, group 1: lymphopenia-returned to normal; group 2: persistent lymphopenia; group 3: never lymphopenic, and the outcome of 28 d were recorded. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow coma scale (GCS), injury severity score (ISS) and massive blood transfusion were collected. Perform statistical analysis on the collected clinical data to understand the trend of lymphocyte changes in early trauma and the relationship with prognosis. In order to eliminate the interference of age, stratification was carried out according to whether the age was ≥ 65 years old, in different age groups, they were grouped according to whether the length of stay was ≥ 28 d, and the relationship between lymphocyte trend and length of stay was discussed. Results: A total of 83 patients were included, 66 males and 17 females. The main injury mechanisms were traffic accident injuries and high-altitude fall injuries. The average ISS was (30±11) points. 65 patients had lymphopenia on the day of injury, 32 of them returned to normal on the 5th day, and the rest did not recover; the other 18 patients had normal lymphocyte levels after injury. Patients which are failure to normalize lymphopenia within the first 5 days following admission was related with the long hospitalization time and higher 28 d mortality rate. After further stratification by age, failure to normalize lymphopenia within the first 5 days following admission in the elderly group (age ≥65 years) was a risk factor for prolonged hospital stay (≥28 d), P=0.04. While in younger group, a high level of neutrophils within the first 5 d following admission was a risk factor for bad outcome. Conclusion: A failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality and longer hospital stay. This study reveals lymphocytes can be used as a reliable indicator for the prognostic evaluation.

Key words: Severe trauma, Lymphopenia, Innate immunity, Systemic inflammatory response syndrome

CLC Number: 

  • R641

Table 1

Baseline data of patients with severe multiple injuries"

Variable Value
Age/years, ${\bar x}$±s 50±17
Gender, n (%)
  Male 66(79.5)
  Female 17(20.5)
Mechanism of injury, n (%)
  Traffic injury 37(44.6)
  High falling injury 30(36.1)
  Tumbles injury 6(7.2)
  Blast injury 2(2.4)
ISS, ${\bar x}$±s 30±11
GCS, M(P25, P75) 10 (3, 15)
Lactate/(mmol/L), ${\bar x}$±s 2.7±2.1
Base excess/(mmol/L), ${\bar x}$±s -3.9±3.6
Cell count/ (× 109/L), ${\bar x}$±s
  Neutrophils on arrival 11.02±4.47
  Lymphocytes on arrival 1.01±0.52
Massive blood transfusion, n(%) 34 (41.1)
Los/d, ${\bar x}$±s 22±16
28 d mortality, n (%) 5 (6)

Figure 1

Change trend of peripheral blood lymphocyte count"

Table 2

Demographics of each group based upon pattern of lymphocyte count"

Variable Group 1 (n=32) Group 2 (n=33) Group 3 (n=18) P
Lymphocyte count /(×109/L), ${\bar x}$±s 1.12±0.06 0.58±0.21*Δ 1.25±0.24 < 0.001
Age/years, ${\bar x}$±s 42±14 59±13*Δ 48±19 < 0.001
Gender, n 0.699
  Male 26 27 13
  Female 6 6 5
ISS, ${\bar x}$±s 30±12 32±11 27±10 0.282
GCS, M(P25, P75) 15(12, 15) 13(10, 15) 15(14, 15) 0.062
Lactate/(mmol/L), ${\bar x}$±s 2.46±2.29 3.27±2.33 2.13±1.27 0.141
Base excess/(mmol/L), ${\bar x}$±s -4.01±3.34 -4.49±3.44 -3.06±4.46 0.414
Massive blood transfusion, n 12 16 6 0.370
Los/d, ${\bar x}$±s 19±10 23±11Δ 15±9 0.034
Outcome of 28 d, n 0.004
  Discharge 28 19 16
  Hospital 4 9 2
  Died 0 5 0

Table 3

Relationship between the change of peripheral blood leukocyte and the length of hospital stay after stratification by age"

Items Los < 28 d Los≥28 d OR 95%CI P
Age < 65 years, n 45 13
  Neutrophils
    Return to normal, n 42 2 1
    Remains elevated, n 3 11 10.18 2.66-38.89 0.001
  Lymphocyte
    Return to normal, n 32 5 1
    Remains low, n 13 8 3.93 1.08-14.31 0.067
Age≥65 years, n 13 7
  Neutrophils
    Return to normal, n 10 5 1
    Remains elevated, n 3 2 0.56 0.05-6.63 0.82
  Lymphocyte
    Return to normal, n 12 1 1
    Remains low, n 1 6 2.81 1.18-6.78 0.04
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