• P E Vulliamy, Z B Perkins, K Brohi, and J Manson.
• 1Barts Health NHS Trust, London, United Kingdom 2Centre for Trauma Sciences, Queen Mary University of London, UK.
• Shock. 2015 Oct 1;44 Suppl 2:10-1.

IntroductionPersistent lymphopenia several days after admission is associated with increased mortality in septic and severely injured patients. We hypothesised that severe abnormalities of the lymphocyte count in the early stages of critical illness are associated with poor outcome in emergency general surgical (EGS) patients.MethodsWe performed a retrospective cohort study of EGS patients admitted to ICU at a single institution. Patients were classified into three groups based on the lowest lymphocyte count observed during the first 48 hours of admission. As previously described, severe lymphopenia was defined as a count less than half the lower limit of normal (<0.5x10^9/L); moderate lymphopenia was defined as a count between 0.5-0.9x10^9/L.ResultsThe cohort comprised 173 patients with acute intra-abdominal pathology. Overall mortality was 41% (72/173). Eighty patients (46%) exhibited severe lymphopenia during the first 48 hours of ICU admission. These patients had greater degrees of organ dysfunction compared to those with moderate lymphopenia and without lymphopenia (SOFA score 9[7-11] vs 7[6-10] vs 7[6-9], p = 0.02). Patients with severe lymphopenia also exhibited significantly lower neutrophil counts and monocyte counts (p < 0.01 for all cell lines). Mortality was substantially higher among patients with severe lymphopenia compared to moderately and non-lymphopenic patients (53% vs 31% vs 30%, p = 0.02; Fig. 1).(Figure is included in full-text article.)Conclusion: Early profound lymphopenia is a marker of illness severity in critically unwell EGS patients and is associated with increased mortality. Further investigation of early lymphocyte dysfunction in critically ill patients may lead to novel therapeutic interventions.

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