The Overlooked Immune State in Candidemia: A Risk Factor for Mortality
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphoc...
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doaj-484c063e8d4441239ba29a189747e5102020-11-25T02:08:00ZengMDPI AGJournal of Clinical Medicine2077-03832019-09-01810151210.3390/jcm8101512jcm8101512The Overlooked Immune State in Candidemia: A Risk Factor for MortalityChristian Ortega-Loubon0Beatriz Cano-Hernández1Rodrigo Poves-Alvarez2María Fe Muñoz-Moreno3Patricia Román-García4Sara Balbás-Alvarez5Olga de la Varga-Martínez6Esther Gómez-Sánchez7Estefanía Gómez-Pesquera8Mario Lorenzo-López9Eduardo Tamayo10María Heredia-Rodríguez11Department of Cardiac Surgery, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainDepartment of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainDepartment of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainUnit of Research, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainDepartment of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainDepartment of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainDepartment of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, SpainBioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, SpainBioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, SpainBioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, SpainBioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, SpainBioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, SpainLymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (<i>p</i> < 0.001). Lymphocyte counts <0.703 × 10<sup>9</sup> cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700−0.867, <i>p</i> < 0.001), and lymphocyte count <1.272 × 10<sup>9</sup> cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716−0.866, <i>p</i> < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39−10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24−8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.https://www.mdpi.com/2077-0383/8/10/1512lymphopenialymphocyte countcandidemiamortalityprognosissurvivalimmunosuppression |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christian Ortega-Loubon Beatriz Cano-Hernández Rodrigo Poves-Alvarez María Fe Muñoz-Moreno Patricia Román-García Sara Balbás-Alvarez Olga de la Varga-Martínez Esther Gómez-Sánchez Estefanía Gómez-Pesquera Mario Lorenzo-López Eduardo Tamayo María Heredia-Rodríguez |
spellingShingle |
Christian Ortega-Loubon Beatriz Cano-Hernández Rodrigo Poves-Alvarez María Fe Muñoz-Moreno Patricia Román-García Sara Balbás-Alvarez Olga de la Varga-Martínez Esther Gómez-Sánchez Estefanía Gómez-Pesquera Mario Lorenzo-López Eduardo Tamayo María Heredia-Rodríguez The Overlooked Immune State in Candidemia: A Risk Factor for Mortality Journal of Clinical Medicine lymphopenia lymphocyte count candidemia mortality prognosis survival immunosuppression |
author_facet |
Christian Ortega-Loubon Beatriz Cano-Hernández Rodrigo Poves-Alvarez María Fe Muñoz-Moreno Patricia Román-García Sara Balbás-Alvarez Olga de la Varga-Martínez Esther Gómez-Sánchez Estefanía Gómez-Pesquera Mario Lorenzo-López Eduardo Tamayo María Heredia-Rodríguez |
author_sort |
Christian Ortega-Loubon |
title |
The Overlooked Immune State in Candidemia: A Risk Factor for Mortality |
title_short |
The Overlooked Immune State in Candidemia: A Risk Factor for Mortality |
title_full |
The Overlooked Immune State in Candidemia: A Risk Factor for Mortality |
title_fullStr |
The Overlooked Immune State in Candidemia: A Risk Factor for Mortality |
title_full_unstemmed |
The Overlooked Immune State in Candidemia: A Risk Factor for Mortality |
title_sort |
overlooked immune state in candidemia: a risk factor for mortality |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2019-09-01 |
description |
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (<i>p</i> < 0.001). Lymphocyte counts <0.703 × 10<sup>9</sup> cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700−0.867, <i>p</i> < 0.001), and lymphocyte count <1.272 × 10<sup>9</sup> cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716−0.866, <i>p</i> < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39−10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24−8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome. |
topic |
lymphopenia lymphocyte count candidemia mortality prognosis survival immunosuppression |
url |
https://www.mdpi.com/2077-0383/8/10/1512 |
work_keys_str_mv |
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