Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study

Talita Freitas Manzoli, Artur Figueiredo Delgado, Eduardo Juan Troster, Werther Brunow de Carvalho, Ana Caroline Barreto Antunes, Desirée Mayara Marques, Patrícia Zamberlan, Talita Freitas Manzoli, Artur Figueiredo Delgado, Eduardo Juan Troster, Werther Brunow de Carvalho, Ana Caroline Barreto Antunes, Desirée Mayara Marques, Patrícia Zamberlan

Abstract

Objectives:: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses.

Methods:: We enrolled 14 consecutive patients with sepsis whose legal representatives provided written informed consent. Patients were classified as normal or malnourished based on anthropometric measurements. As an additional evaluation of nutritional status, serum albumin and zinc were measured on the 1st and 7th days of hospitalization. Lymphocyte count was also measured on the 1st and 7th days. Clinicaltrials.gov: NCT02698683.

Results:: Malnutrition prevalence rates were 33.3% and 42.8% based on weight and height, respectively. Laboratory analyses revealed a reduction of serum albumin in 100% of patients and reduction of zinc in 93.3% of patients. A total of 35% of patients had fewer than 500 lymphocytes/mm3 on their first day in the PICU. Lymphocyte counts and zinc concentrations significantly increased during hospitalization.

Conclusions:: Nutritional evaluations, including anthropometric measurements, were not correlated with lymphocyte counts. Lymphocyte counts concomitantly increased with zinc levels, suggesting that micronutrient supplementation benefits patients with sepsis.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
A) Total lymphocyte counts on days 1 and 7 among malnourished and well-nourished children according to weight for age (W/A), B) Total lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to height for age (H/A), C) Total lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to median upper arm circumference (MUAC).
Figure 2
Figure 2
A) CD4+ lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to weight for age (W/A), B) CD4+ lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to height for age (H/A), C) CD4+ lymphocyte counts at days 1 and 7 in malnourished and well-nourished children according to median upper arm circumference (MUAC).
Figure 3
Figure 3
A) CD8+lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to weight for age (W/A), B) CD8+ lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to height for age (H/A), C) CD8+ lymphocyte counts on days 1 and 7 in malnourished and well-nourished children according to median upper arm circumference (MUAC).
Figure 4
Figure 4
Increase in zinc dosage and lymphocyte count between the first and seventh days. A positive Pearson's correlation was found between zinc levels and lymphocyte counts. The Pearson's correlation coefficients between the CD4+ lymphocyte counts and zinc levels on the first day of hospitalization ranged from -0.6618 to 0.4167. The correlation between the CD4+ lymphocyte counts and zinc levels on the seventh day of hospitalization ranged from -0.5659 to 0.7438. The correlation between the CD8+ lymphocyte counts and zinc levels on the first day of hospitalization ranged from -0.6668 to 0.4092. The correlation between the CD8+ lymphocyte counts and zinc levels on the seventh day of hospitalization ranged from -0.3593 to 0.8409.

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