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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Published in:Journal of clinical medicine 2019-09, Vol.8 (10), p.1512
Main Authors: Ortega-Loubon, Christian, Cano-Hernández, Beatriz, Poves-Alvarez, Rodrigo, Muñoz-Moreno, María Fe, Román-García, Patricia, Balbás-Alvarez, Sara, de la Varga-Martínez, Olga, Gómez-Sánchez, Esther, Gómez-Pesquera, Estefanía, Lorenzo-López, Mario, Tamayo, Eduardo, Heredia-Rodríguez, María
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container_issue 10
container_start_page 1512
container_title Journal of clinical medicine
container_volume 8
creator Ortega-Loubon, Christian
Cano-Hernández, Beatriz
Poves-Alvarez, Rodrigo
Muñoz-Moreno, María Fe
Román-García, Patricia
Balbás-Alvarez, Sara
de la Varga-Martínez, Olga
Gómez-Sánchez, Esther
Gómez-Pesquera, Estefanía
Lorenzo-López, Mario
Tamayo, Eduardo
Heredia-Rodríguez, María
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 (p < 0.001). Lymphocyte counts
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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 &lt; 0.001). Lymphocyte counts &lt;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 &lt; 0.001), and lymphocyte count &lt;1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p &lt; 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.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm8101512</identifier><identifier>PMID: 31547077</identifier><language>eng</language><publisher>MDPI</publisher><ispartof>Journal of clinical medicine, 2019-09, Vol.8 (10), p.1512</ispartof><rights>2019 by the authors. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c355t-ee6d146c07d9158524469576112b25d002fef781a1a87fcb05e9e5dc389012763</citedby><cites>FETCH-LOGICAL-c355t-ee6d146c07d9158524469576112b25d002fef781a1a87fcb05e9e5dc389012763</cites><orcidid>0000-0002-4428-2631 ; 0000-0002-0596-8366 ; 0000-0002-2208-8969 ; 0000-0002-5355-554X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832466/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832466/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27900,27901,36989,53765,53767</link.rule.ids></links><search><creatorcontrib>Ortega-Loubon, Christian</creatorcontrib><creatorcontrib>Cano-Hernández, Beatriz</creatorcontrib><creatorcontrib>Poves-Alvarez, Rodrigo</creatorcontrib><creatorcontrib>Muñoz-Moreno, María Fe</creatorcontrib><creatorcontrib>Román-García, Patricia</creatorcontrib><creatorcontrib>Balbás-Alvarez, Sara</creatorcontrib><creatorcontrib>de la Varga-Martínez, Olga</creatorcontrib><creatorcontrib>Gómez-Sánchez, Esther</creatorcontrib><creatorcontrib>Gómez-Pesquera, Estefanía</creatorcontrib><creatorcontrib>Lorenzo-López, Mario</creatorcontrib><creatorcontrib>Tamayo, Eduardo</creatorcontrib><creatorcontrib>Heredia-Rodríguez, María</creatorcontrib><title>The Overlooked Immune State in Candidemia: A Risk Factor for Mortality</title><title>Journal of clinical medicine</title><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 (p &lt; 0.001). Lymphocyte counts &lt;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 &lt; 0.001), and lymphocyte count &lt;1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p &lt; 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. 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