Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Méndez, Raúl; Menéndez, Rosario; Amara-Elori, Isabel; Feced, Laura; Piró, Alba; Ramírez, Paula; Sempere, Amparo; Ortega, Alicia; Bermejo-Martín, Jesús F.; Torres, Antoni
• Is Part Of: Journal of infection. Volume 78:Issue 6(2019)
• Page Start: 423
• Page End: 431
• Publication Date: 2019-06
• Subjects: Pneumonia -- Adaptive immunity -- Host response; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.04.006
• Languages: English
• ISSNs: 0163-4453

Abstract

Abstract: Objectives: Lymphopenic (<724 lymphocytes/µL) community-acquired pneumonia (L-CAP) is an immunophenotype with an increased risk of mortality. We aimed to characterize the l -CAP immunophenotype though lymphocyte subsets and the inflammatory response and its relationship with severity at presentation and outcome. Methods: Prospective study of 217 immunocompetent patients hospitalized for CAP. Lymphocyte subsets (CD4 +, CD8 +, CD19 +, and natural killer [NK] cells) and inflammatory cytokines were analyzed on days 1 and 4, and immunoglobulin subclasses were analyzed on day 1 in a nested group. Results: 39% of patients showed l -CAP, with decreased levels of all lymphocyte subsets with a partial recovery of CD4 + and CD8 + cells by day 4. l -CAP patients exhibited higher initial severity and systemic levels of interleukin (IL)-8, IL-10, granulocyte colony-stimulating factor, and monocyte chemoattractant protein-1. Initial IgG2 levels were lower in patients with <724 lymphocytes/µL and positively correlated with ALC, CD4 +, and CD19 + cell counts. Low CD4 + counts (<129 cells/µL) also independently predicted 30-day mortality after adjusting for age, gender, and the CURB-65 score. Conclusions: l -CAP is characterized by CD4 + depletion, a higher inflammatory response, and low IgG2 levels that correlated with greater severity at presentation and worse prognosis. l -CAP is an immunophenotype useful for rapidly recognizing severity.