The Association Between Absolute Lymphocyte Count and Long-Term Mortality in Critically Ill Medical Patients: Propensity Score-Based Analyses

Abstract

Yi-Chun Hsiao,1,* Pei-Yi Shen,1,* Li-Ting Wong,2 Ming-Cheng Chan,3,4 Wen-Cheng Chao3– 6 1Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 2Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; 3Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; 5Big Data Center, Chung Hsing University, Taichung, Taiwan; 6Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Wen-Cheng Chao, Department of Critical Care Medicine, Taichung Veterans General Hospital, No, 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City, 40705, Taiwan, Email [email protected]: Absolute lymphocyte count (ALC) has been implicated with short-term outcomes in a number of diseases, and we aimed to investigate the association between week-one ALC and long-term mortality in patients who were admitted to the medical intensive care units (ICUs).Methods: We enrolled patients who were admitted to the medical ICUs at the Taichung Veterans General Hospital, a referral centre located in central Taiwan, between 2015 and 2020 to conduct this retrospective cohort study. The outcome of interest was long-term all-cause mortality, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to determine the association. Furthermore, we employed propensity score-matching (PSM) and weighting techniques, consisting of inverse probability of treatment weighting (IPTW) and covariate balancing propensity score (CBPS), to confirm the association between ALC and mortality.Results: A total of 5722 critically ill patients were enrolled, and the one-year mortality was 44.8%. The non-survivor group had a lower ALC (1549, 1027– 2388 vs 1948, 1373– 2743 counts/μL, p< 0.01) compared with those in the survivor group. Cox regression showed that low ALC was independently associated with mortality (adjHR 1.091, 95% CI 1.050– 1.134). Propensity score-based analyses demonstrated the robust association, with adjHRs in the original, PSM, IPTW, and CBPS populations of 1.327 (95% CI 1.224– 1.438), 1.301 (95% CI 1.188– 1.424), 1.292 (95% CI 1.186– 1.407), and 1.297 (95% CI 1.191– 1.412), respectively. Sensitivity analyses further showed that the association between low ALC and mortality existed in a dose-response manner.Conclusion: We found that low ALC was associated with long-term mortality in critically ill patients; further studies are warranted to validate and translate these findings into clinical utility.Keywords: absolute lymphocyte counts, critical illness, mortality, long-term outcome, propensity score

Keywords

• absolute lymphocyte counts
• critical illness
• mortality
• long-term outcome
• propensity score