Abstract
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 (p < 0.001). Lymphocyte counts <0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700–0.867, p < 0.001), and lymphocyte count <1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p < 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.
Highlights
Candidemia is a deadly infection found all over the world, accounting for 9% of all nosocomial bloodstream infection (BSI) [1,2]. This infection is associated with considerable morbidity and mortality, including prolonged hospital stays and increased healthcare costs, with 30% to 50% occurring in patients in the intensive care unit (ICU) [3]
Our study aimed to describe the characteristics between survivors and non-survivors in patients with candidemia and determine if lymphocyte count is an independent predictor of in-hospital mortality and impacts prognosis
Univariate regression analysis identified age (OR, 1.03; 95% confidence interval (CI), 1.02 to 1.05), prolonged mechanical ventilation (PMV) (OR, 2.73; 95% CI, 1.69 to 4.43), septic shock (OR, 2.95; 95% CI, 1.81 to 4.80), candida score (OR, 1.28; 95% CI, 1.13 to 1.45), as risk factors for mortality
Summary
Candidemia is a deadly infection found all over the world, accounting for 9% of all nosocomial bloodstream infection (BSI) [1,2] This infection is associated with considerable morbidity and mortality, including prolonged hospital stays and increased healthcare costs, with 30% to 50% occurring in patients in the intensive care unit (ICU) [3]. The crude candidemia mortality ranges from approximately 22% to 75%, despite advances in diagnosis and therapy [4,5,6,7,8]. Despite advancements such as effective broad-spectrum antifungals and recent management guidelines, the incidence of candidemia has doubled over the past two decades [7,9]. Candidemia is the fourth leading cause of BSI in hospitalized patients in the United States, the seventh leading cause in Europe, and the third in patients admitted to the ICU [7,12,13,14]
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