Admission Lymphopenia Predicts Infectious Complications and Mortality in Traumatic Brain Injury Victims

Brady Campbell; Daniel Budreau; Sophia Williams-Perez; Subhashish Chakravarty; Colette Galet; Patrick McGonagill

doi:10.1097/SHK.0000000000001872

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Admission Lymphopenia Predicts Infectious Complications and Mortality in Traumatic Brain Injury Victims

Journal article

Peer reviewed

Admission Lymphopenia Predicts Infectious Complications and Mortality in Traumatic Brain Injury Victims

Brady Campbell, Daniel Budreau, Sophia Williams-Perez, Subhashish Chakravarty, Colette Galet and Patrick McGonagill

Shock (Augusta, Ga.), Vol.57(2), pp.189-198

02/01/2022

DOI: 10.1097/SHK.0000000000001872

PMID: 34618726

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Abstract

Traumatic brain injury (TBI) is a major cause of mortality and disability associated with increased risk of secondary infections. Identifying a readily available biomarker may help direct TBI patient care. Herein, we evaluated whether admission lymphopenia could predict outcomes of TBI patients. This is a 10-year retrospective review of TBI patients with a head Abbreviated Injury Score 2 to 6 and absolute lymphocyte counts (ALC) collected within 24 h of admission. Exclusion criteria were death within 24 h of admission and presence of bowel perforation on admission. Demographics, admission data, injury severity score, mechanism of injury, and outcomes were collected. Association between baseline variables and outcomes was analyzed. We included 2,570 patients; 946 (36.8%) presented an ALC ≤1,000 on admission (lymphopenic group). Lymphopenic patients were significantly older, less likely to smoke, and more likely to have heart failure, hypertension, or chronic kidney disease. Lymphopenia was associated with increased risks of mortality (OR = 1.903 [1.389-2.608]; P < 0.001) and pneumonia (OR = 1.510 [1.081-2.111]; P = 0.016), increased LOS (OR = 1.337 [1.217-1.469]; P < 0.001), and likelihood of requiring additional healthcare resources at discharge (OR = 1.669 [1.344-2.073], P < 0.001). Additionally, lymphopenia increased the risk of early in-hospital death (OR = 1.459 [1.097-1.941]; P = 0.009). Subgroup analysis showed that lymphopenia was associated with mortality in polytrauma patients and those who presented with two or more concurrent types of TBI. In all subgroup analyses, lymphopenia was associated with longer length of stay and discharge requiring higher level of care. A routine complete blood count with differential for all TBI patients may help predict patient outcomes and direct care accordingly.

Adult

Aged

Brain Injuries, Traumatic - complications

Brain Injuries, Traumatic - mortality

Cohort Studies

Female

Forecasting - methods

Hospitalization - statistics & numerical data

Humans

Infections - epidemiology

Infections - etiology

Infections - mortality

Injury Severity Score

Iowa

Lymphopenia - blood

Lymphopenia - complications

Male

Middle Aged

Mortality - trends

Registries - statistics & numerical data

Retrospective Studies

Details

Title: Subtitle: Admission Lymphopenia Predicts Infectious Complications and Mortality in Traumatic Brain Injury Victims
Creators: Brady Campbell - Roy J. and Lucille A. Carver College of Medicine
Daniel Budreau - University of Iowa
Sophia Williams-Perez - Roy J. and Lucille A. Carver College of Medicine
Subhashish Chakravarty - Freelance Consultant, Marion, Collins Aerospace, Cedar Rapids IA.
Colette Galet - University of Iowa
Patrick McGonagill - University of Iowa
Resource Type: Journal article
Publication Details: Shock (Augusta, Ga.), Vol.57(2), pp.189-198
DOI: 10.1097/SHK.0000000000001872
PMID: 34618726
ISSN: 1540-0514
eISSN: 1540-0514
Language: English
Date published: 02/01/2022
Academic Unit: Statistics and Actuarial Science; Surgery
Record Identifier: 9984322794502771

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9 Times Cited - Web of Science

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