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.
Keywords
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Article info
Publication history
Published online: April 12, 2019
Accepted:
April 2,
2019
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of The British Infection Association.
