Abstract：
BACKGROUND: Influenza virus causes significant global annual morbidity and mortality. Thrombocytopenia is recognized as a poor prognostic factor in sepsis and is associated with mortality, while lymphopenia has been established as a poor prognostic factor in other viral infections. We aimed to assess the incidence of thrombocytopenia and lymphopenia in seasonal influenza and their effect on clinical outcomes.
METHODS: This single-center, retrospective, cohort study included consecutive adult patients, hospitalized in Rabin Medical Center between October 2017 and April 2018, with laboratory-confirmed influenza. Patients were grouped according to blood counts on admission: (1) thrombocytopenia (<150 K/mL), (2) lymphopenia (<0.5 K/mL), and (3) both thrombocytopenia and lymphopenia. Patients without thrombocytopenia and lymphopenia were designated as controls. The primary outcome was 30-day all-cause mortality. Risk factors were identified by univariable and multivariable analyses, using logistic regression and reported as odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: A total of 625 patients were included, 112 (18%) had thrombocytopenia, 98 (15.6%) had lymphopenia, and 107 (17%) had both. The crude 30-day all-cause mortality was 7.6% (48/625). Mortality rates were 7.1% (8/112) for the thrombocytopenia group, 11.2% (11/98) for the lymphopenia group, and 14.9% (16/107) for patients with both versus 4.2% (13/308) in the control (p = 0.000 for all). In a multivariable regression model, significant thrombocytopenia (<100 K/μL) [OR 5.07 (95% CI 1.5-16.2)], age [OR 1.07 (95% CI 1.02-1.11)], time to oseltamivir [OR 1.006 (95% CI 1.002-1.11)], and significant respiratory support [OR 8.85 (3.4-22.6)] were associated with 30-day all-cause mortality.
CONCLUSIONS: Patients hospitalized with seasonal influenza and thrombocytopenia <100 K/mL on admission, have an increased 30-day all-cause mortality.
METHODS: This single-center, retrospective, cohort study included consecutive adult patients, hospitalized in Rabin Medical Center between October 2017 and April 2018, with laboratory-confirmed influenza. Patients were grouped according to blood counts on admission: (1) thrombocytopenia (<150 K/mL), (2) lymphopenia (<0.5 K/mL), and (3) both thrombocytopenia and lymphopenia. Patients without thrombocytopenia and lymphopenia were designated as controls. The primary outcome was 30-day all-cause mortality. Risk factors were identified by univariable and multivariable analyses, using logistic regression and reported as odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: A total of 625 patients were included, 112 (18%) had thrombocytopenia, 98 (15.6%) had lymphopenia, and 107 (17%) had both. The crude 30-day all-cause mortality was 7.6% (48/625). Mortality rates were 7.1% (8/112) for the thrombocytopenia group, 11.2% (11/98) for the lymphopenia group, and 14.9% (16/107) for patients with both versus 4.2% (13/308) in the control (p = 0.000 for all). In a multivariable regression model, significant thrombocytopenia (<100 K/μL) [OR 5.07 (95% CI 1.5-16.2)], age [OR 1.07 (95% CI 1.02-1.11)], time to oseltamivir [OR 1.006 (95% CI 1.002-1.11)], and significant respiratory support [OR 8.85 (3.4-22.6)] were associated with 30-day all-cause mortality.
CONCLUSIONS: Patients hospitalized with seasonal influenza and thrombocytopenia <100 K/mL on admission, have an increased 30-day all-cause mortality.
摘要：
引言流感病毒引起显著的全球年发病率和死亡率。血小板减少症被认为是脓毒症的不良预后因素，并与死亡率相关。而淋巴细胞减少已被确定为其他病毒感染的不良预后因素。我们旨在评估季节性流感中血小板减少和淋巴细胞减少的发生率及其对临床结局的影响。方法这种单中心,回顾性,队列研究包括连续的成年患者，2017年10月至2018年4月期间在拉宾医疗中心住院，实验室确诊为流感。根据入院时的血细胞计数对患者进行分组:1.血小板减少症（<150K/ml），2.淋巴细胞减少（<0.5K/ml），and3.血小板减少和淋巴细胞减少。没有血小板减少症和淋巴细胞减少症的患者被指定为对照。主要结果是30天全因死亡率。通过单变量和多变量分析确定风险因素，使用逻辑回归并报告为比值比(OR)和95%置信区间(CI)。结果共纳入625例患者,112（18%）有血小板减少症，98例（15.6%）淋巴细胞减少，107例（17%）淋巴细胞减少。粗30天全因死亡率为7.6%(48/625)。血小板减少组的死亡率为7.1%(8/112),淋巴细胞减少组11.2%(11/98)，和14.9%（16/107）的患者与4.2%（13/308）的对照组（p=0.000）。在多变量回归模型中，显着血小板减少症（<100K/微升）[OR5.07，（95％CI1.5-16.2）[，年龄[OR1.07，（95%CI1.02-1.11）]，奥司他韦的时间]或1.006，（95%1.002-1.11）]，和显著的呼吸支持[OR8.85，（3.4-22.6）]，与30天全因死亡率相关。结论季节性流感住院患者入院时血小板减少<100K/mL,增加了30天的全因死亡率。
