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Abstract：
OBJECTIVE: The objective of the study was to assess the clinical predictive value of the dynamics of absolute lymphocyte count (ALC) for 90-day all-cause mortality in sepsis patients in intensive care unit (ICU).
METHODS: Retrospective cohort study using big data.
METHODS: This study was conducted using the Medical Information Mart for Intensive Care IV database V.2.0 database.
METHODS: The primary outcome was 90-day all-cause mortality.
METHODS: Patients were included if they were diagnosed with sepsis on the first day of ICU admission. Exclusion criteria were ICU stay under 24 hours; the absence of lymphocyte count on the first day; extremely high lymphocyte count (>10×109/L); history of haematolymphatic tumours, bone marrow or solid organ transplants; survival time under 72 hours and previous ICU admissions. The analysis ultimately included 17 329 sepsis patients.
RESULTS: The ALC in the non-survivors group was lower on days 1, 3, 5 and 7 after admission (p<0.001). The ALC on day 7 had the highest area under the curve (AUC) value for predicting 90-day mortality. The cut-off value of ALC on day 7 was 1.0×109/L. In the restricted cubic spline plot, after multivariate adjustments, patients with higher lymphocyte counts had a better prognosis. After correction, in the subgroups with Sequential Organ Failure Assessment score ≥6 or age ≥60 years, ALC on day 7 had the lowest HR value (0.79 and 0.81, respectively). On the training and testing set, adding the ALC on day 7 improved all prediction models\' AUC and average precision values.
CONCLUSIONS: Dynamic changes of ALC are closely associated with 90-day all-cause mortality in sepsis patients. Furthermore, the ALC on day 7 after admission is a better independent predictor of 90-day mortality in sepsis patients, especially in severely ill or young sepsis patients.
METHODS: Retrospective cohort study using big data.
METHODS: This study was conducted using the Medical Information Mart for Intensive Care IV database V.2.0 database.
METHODS: The primary outcome was 90-day all-cause mortality.
METHODS: Patients were included if they were diagnosed with sepsis on the first day of ICU admission. Exclusion criteria were ICU stay under 24 hours; the absence of lymphocyte count on the first day; extremely high lymphocyte count (>10×109/L); history of haematolymphatic tumours, bone marrow or solid organ transplants; survival time under 72 hours and previous ICU admissions. The analysis ultimately included 17 329 sepsis patients.
RESULTS: The ALC in the non-survivors group was lower on days 1, 3, 5 and 7 after admission (p<0.001). The ALC on day 7 had the highest area under the curve (AUC) value for predicting 90-day mortality. The cut-off value of ALC on day 7 was 1.0×109/L. In the restricted cubic spline plot, after multivariate adjustments, patients with higher lymphocyte counts had a better prognosis. After correction, in the subgroups with Sequential Organ Failure Assessment score ≥6 or age ≥60 years, ALC on day 7 had the lowest HR value (0.79 and 0.81, respectively). On the training and testing set, adding the ALC on day 7 improved all prediction models\' AUC and average precision values.
CONCLUSIONS: Dynamic changes of ALC are closely associated with 90-day all-cause mortality in sepsis patients. Furthermore, the ALC on day 7 after admission is a better independent predictor of 90-day mortality in sepsis patients, especially in severely ill or young sepsis patients.
摘要：
目的：本研究的目的是评估绝对淋巴细胞计数（ALC）动态对重症监护病房（ICU）脓毒症患者90天全因死亡率的临床预测价值。
方法：使用大数据的回顾性队列研究。
方法：本研究使用医学信息集市重症监护IV数据库V.2.0数据库进行。
方法：主要结局是90天全因死亡率。
方法：如果患者在入住ICU的第一天被诊断为脓毒症，则纳入患者。排除标准为ICU停留24小时以下；第一天没有淋巴细胞计数；淋巴细胞计数极高（>10×109/L）；血淋巴肿瘤病史，骨髓或实体器官移植；72小时以下的存活时间和以前的ICU入院时间。分析最终包括17329例脓毒症患者。
结果：非幸存者组的ALC在入院后第1、3、5和7天降低（p<0.001）。第7天的ALC具有用于预测90天死亡率的最高曲线下面积(AUC)值。第7天ALC的截断值为1.0×109/L。在受限三次样条图中，经过多变量调整后，淋巴细胞计数较高的患者预后较好.校正后,在序贯器官衰竭评估评分≥6或年龄≥60岁的亚组中，第7天的ALC具有最低的HR值(分别为0.79和0.81)。在训练和测试集上，在第7天添加ALC改善了所有预测模型的AUC和平均精度值。
结论：脓毒症患者ALC的动态变化与90天全因死亡率密切相关。此外，入院后第7天的ALC是脓毒症患者90天死亡率的更好的独立预测因子，尤其是在重症或年轻的败血症患者中。
方法：使用大数据的回顾性队列研究。
方法：本研究使用医学信息集市重症监护IV数据库V.2.0数据库进行。
方法：主要结局是90天全因死亡率。
方法：如果患者在入住ICU的第一天被诊断为脓毒症，则纳入患者。排除标准为ICU停留24小时以下；第一天没有淋巴细胞计数；淋巴细胞计数极高（>10×109/L）；血淋巴肿瘤病史，骨髓或实体器官移植；72小时以下的存活时间和以前的ICU入院时间。分析最终包括17329例脓毒症患者。
结果：非幸存者组的ALC在入院后第1、3、5和7天降低（p<0.001）。第7天的ALC具有用于预测90天死亡率的最高曲线下面积(AUC)值。第7天ALC的截断值为1.0×109/L。在受限三次样条图中，经过多变量调整后，淋巴细胞计数较高的患者预后较好.校正后,在序贯器官衰竭评估评分≥6或年龄≥60岁的亚组中，第7天的ALC具有最低的HR值(分别为0.79和0.81)。在训练和测试集上，在第7天添加ALC改善了所有预测模型的AUC和平均精度值。
结论：脓毒症患者ALC的动态变化与90天全因死亡率密切相关。此外，入院后第7天的ALC是脓毒症患者90天死亡率的更好的独立预测因子，尤其是在重症或年轻的败血症患者中。
