Postoperative lymphopenia: An independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study

Postoperative lymphopenia has been proposed as a risk factor for postoperative infections but has never been identified as such in a multivariate analysis. Postoperative pneumonia (POP) is one of the most common complications after lung cancer surgery and is associated with a worse outcome. We aimed...

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Bibliographic Details
Published in:PloS one 2018-10, Vol.13 (10), p.e0205237-e0205237
Main Authors: Dupont, Guillaume, Flory, Laura, Morel, Jérôme, Lukaszewicz, Anne-Claire, Patoir, Arnaud, Presles, Emilie, Monneret, Guillaume, Molliex, Serge
Format: Article
Language:English
Subjects:
Anesthesia
Antibiotics
Bernard, Claude (1813-1878)
Biology and Life Sciences
Blood
Cancer
Cancer surgery
Cell number
Cholecystectomy
Chronic obstructive pulmonary disease
Complications
Complications and side effects
Health risks
Hospitals
Immunosuppression
Infections
Laparoscopy
Lobectomy
Lung cancer
Lung diseases
Lymphocytes
Lymphocytopenia
Lymphopenia
Medicine and Health Sciences
Multivariate analysis
Patients
Pneumonia
Postoperative complications
Regression analysis
Regression models
Risk analysis
Risk factors
Sepsis
Surgery
Thoracic surgery
Trauma
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Summary:Postoperative lymphopenia has been proposed as a risk factor for postoperative infections but has never been identified as such in a multivariate analysis. Postoperative pneumonia (POP) is one of the most common complications after lung cancer surgery and is associated with a worse outcome. We aimed to evaluate the association between postoperative lymphopenia and POP after lung cancer surgery. Patients admitted for lung cancer surgery (lobectomy, bilobectomy, or pneumonectomy) aged ≥ 18 years and with no history of an immunosuppressive state were eligible for inclusion. Lymphocyte counts were determined in blood drawn on the day before surgery and at postoperative days 1, 3 and 7. POP diagnosis was based on clinical, biological and radiological data. A logistic regression model adjusted on currently described risk factors for POP was used to explain the onset of this condition. Two hundred patients were included, of whom 43 (21.5%) developed POP. Preoperative lymphocyte count was 1.8±0.6x10(9) cells/L and 2.0±0.7x10(9) cells/L in patients with and without POP, respectively (P = .091). In both groups, the lymphocyte count nadir occurred at postoperative day 1. In multivariate analysis, lymphopenia at postoperative day 1 was significantly associated with increased risk of POP (odds ratio: 2.63, 95% CI [1.03-5.40]). POP rate at postoperative day 7 was higher in patients presenting low lymphocyte counts (≤1.19x10(9) cells/L) at postoperative day 1 (P = .003). Our study showed that lymphopenia following lung cancer surgery was maximal at postoperative day 1 and was associated with POP.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0205237