Abstract：
OBJECTIVE: Sepsis causes significant worldwide morbidity and mortality. Inability to clear an infection and secondary infections are known complications in severe sepsis and likely result in worsened outcomes. We sought to characterize risk factors of these complications.
METHODS: We performed a secondary analysis of clinical data from 401 subjects enrolled in the PHENOtyping sepsis-induced Multiple organ failure Study. We examined factors associated with prolonged infection, defined as infection that continued to be identified 7 days or more from initial identification, and secondary infection, defined as new infections identified ≥ 3 days from presentation. Multivariable adjustment was performed to examine laboratory markers of immune depression, with immunocompromised and immunocompetent subjects analyzed separately.
RESULTS: Illness severity, immunocompromised status, invasive procedures, and site of infection were associated with secondary infection and/or prolonged infection. Persistent lymphopenia, defined as an absolute lymphocyte count (ALC) < 1000 cells/µL twice in the first five days, and persistent neutropenia, defined as absolute neutrophil count (ANC) < 1000 cells/µL twice in the first five days, were associated with secondary and prolonged infections. When adjusted in multivariable analysis, persistent lymphopenia remained associated with secondary infection in both immunocompromised (aOR = 14.19, 95% CI [2.69, 262.22] and immunocompetent subjects (aOR = 2.09, 95% CI [1.03, 4.17]). Persistent neutropenia was independently associated with secondary infection in immunocompromised subjects (aOR = 5.34, 95% CI [1.92, 15.84]). Secondary and prolonged infections were associated with worse outcomes, including death.
CONCLUSIONS: Laboratory markers of immune suppression can be used to predict secondary infection. Lymphopenia is an independent risk factor in immunocompromised and immunocompetent patients for secondary infection.
METHODS: We performed a secondary analysis of clinical data from 401 subjects enrolled in the PHENOtyping sepsis-induced Multiple organ failure Study. We examined factors associated with prolonged infection, defined as infection that continued to be identified 7 days or more from initial identification, and secondary infection, defined as new infections identified ≥ 3 days from presentation. Multivariable adjustment was performed to examine laboratory markers of immune depression, with immunocompromised and immunocompetent subjects analyzed separately.
RESULTS: Illness severity, immunocompromised status, invasive procedures, and site of infection were associated with secondary infection and/or prolonged infection. Persistent lymphopenia, defined as an absolute lymphocyte count (ALC) < 1000 cells/µL twice in the first five days, and persistent neutropenia, defined as absolute neutrophil count (ANC) < 1000 cells/µL twice in the first five days, were associated with secondary and prolonged infections. When adjusted in multivariable analysis, persistent lymphopenia remained associated with secondary infection in both immunocompromised (aOR = 14.19, 95% CI [2.69, 262.22] and immunocompetent subjects (aOR = 2.09, 95% CI [1.03, 4.17]). Persistent neutropenia was independently associated with secondary infection in immunocompromised subjects (aOR = 5.34, 95% CI [1.92, 15.84]). Secondary and prolonged infections were associated with worse outcomes, including death.
CONCLUSIONS: Laboratory markers of immune suppression can be used to predict secondary infection. Lymphopenia is an independent risk factor in immunocompromised and immunocompetent patients for secondary infection.
摘要：
目的：脓毒症在全球范围内引起显著的发病率和死亡率。无法清除感染和继发感染是严重脓毒症的已知并发症，并可能导致恶化的结果。我们试图描述这些并发症的危险因素。
方法：我们对401名受试者的临床数据进行了二次分析。我们检查了与长期感染相关的因素，定义为从初始识别起持续识别7天或更长时间的感染，和继发感染，定义为在出现后≥3天发现的新感染。进行多变量调整以检查免疫抑制的实验室标志物，分别对免疫功能低下和免疫功能正常的受试者进行分析。
结果：疾病严重程度，免疫受损状态，侵入性程序，感染部位与继发感染和/或长期感染有关。持续性淋巴细胞减少症,定义为在前五天内两次绝对淋巴细胞计数（ALC）<1000个细胞/μL，和持续性中性粒细胞减少症,定义为中性粒细胞绝对计数（ANC）在前五天内两次<1000个细胞/µL，与继发和长期感染有关。在多变量分析中调整后，在免疫功能低下的受试者(aOR=14.19,95%CI[2.69,262.22]和免疫功能正常的受试者(aOR=2.09,95%CI[1.03,4.17])中,持续性淋巴细胞减少仍然与继发感染相关.在免疫功能低下的受试者中，持续的中性粒细胞减少与继发感染独立相关(aOR=5.34,95%CI[1.92,15.84])。继发和长期感染与较差的结果相关，包括死亡。
结论：免疫抑制的实验室标志物可用于预测继发感染。淋巴细胞减少是免疫功能低下和免疫功能正常患者继发感染的独立危险因素。
方法：我们对401名受试者的临床数据进行了二次分析。我们检查了与长期感染相关的因素，定义为从初始识别起持续识别7天或更长时间的感染，和继发感染，定义为在出现后≥3天发现的新感染。进行多变量调整以检查免疫抑制的实验室标志物，分别对免疫功能低下和免疫功能正常的受试者进行分析。
结果：疾病严重程度，免疫受损状态，侵入性程序，感染部位与继发感染和/或长期感染有关。持续性淋巴细胞减少症,定义为在前五天内两次绝对淋巴细胞计数（ALC）<1000个细胞/μL，和持续性中性粒细胞减少症,定义为中性粒细胞绝对计数（ANC）在前五天内两次<1000个细胞/µL，与继发和长期感染有关。在多变量分析中调整后，在免疫功能低下的受试者(aOR=14.19,95%CI[2.69,262.22]和免疫功能正常的受试者(aOR=2.09,95%CI[1.03,4.17])中,持续性淋巴细胞减少仍然与继发感染相关.在免疫功能低下的受试者中，持续的中性粒细胞减少与继发感染独立相关(aOR=5.34,95%CI[1.92,15.84])。继发和长期感染与较差的结果相关，包括死亡。
结论：免疫抑制的实验室标志物可用于预测继发感染。淋巴细胞减少是免疫功能低下和免疫功能正常患者继发感染的独立危险因素。
