Lymphopenia as a risk factor for mortality in patients with liver cirrhosis.

Introduction and Objectives

Patients with cirrhosis develop immune dysfunction where a decrease in CD4 lymphocytes has been described in up to 65% of patients. The aim of this study is to evaluate if lymphopenia is a risk factor for mortality in patients with liver cirrhosis during hospitalization

Materials and Patients

A retrospective, observational, cross-sectional, and single-center study was carried out in a period from October 2023 to May 2024, which included patients >18 years of age with diagnosis of liver cirrhosis who were admitted to the Gastroenterology service due to some acute decompensation and who died in that hospitalization, who had absolute lymphocyte determination on admission. Descriptive statistics were performed with frequencies and percentages and the variables were analyzed according to their free or normal distribution with Mann-Whitney U or Student's t, respectively. Chi-square was used to assess the risk of mortality associated with lymphopenia.

Results

67 patients were included females predominated 39 (58.2%), with a mean age of 58±10 years, the most frequent admission diagnoses were variceal hemorrhage in 29 (43%) patients, followed by the diagnosis of acute over chronic liver disease (ACLF) 13 (19%) and in third place hepatic encephalopathy and acute kidney injury 8 (11%) respectively. The mean MELD 3.0 was 21±9 and most patients were in Child Pugh B 32 (47.8%). Patients with ascites were 48 (71.6%), hepatic encephalopathy 33 (49.3%), acute renal injury 25 (37.3%), and spontaneous bacterial peritonitis 8 (11.9%). 52.2% (35) of the patients had absolute lymphocytes <1000 on admission.

The OR for lymphocytes <500 at admission was 4.1 95% CI (1.04-16.18) for the outcome and mortality.

Mortality in this group of patients was 17.9% (12), with ACLF being the main cause in 11 patients, which is equivalent to 91%, 75% of patients had lymphopenia (9).

Conclusions

The absolute lymphocyte count < 500 at admission is a risk factor for mortality in patients admitted to hospitalization due to an acute decompensation event.

Ethics Statement: It is considered risk-free research and the project was approved by the ethics committee

Declaration of Interest: None.

Funding: This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Características de los pacientes con linfopenia y cirrosis

Edad, media, DE	58.12 ± 10.92
Género
Mujeres, No, %	39 (58.2)
Hombres, No, %	28 (41.8)
Child-Pugh-Turcotte
A, No, %	5 (7.5)
B, No, %	32 (47.8)
C, No, %	30 (44.8)
Diagnósticos de ingreso
Hemorragia variceal, No, %	29 (43.3)
Falla hepática aguda sobre crónica No, %	13 (19.4)
Encefalopatía hepática No, %	8 (19.4)
Lesión renal aguda No, %	8 (19.4)
Mortalidad No, %	12 (17.9)
Linfopenia
<1000 linfocitos absolutos No, %	35 (52.2)
Comorbilidades No, %	52 (76.6)
MELD 3.0, media, DE	21±9
Encefalopatía hepática No, %	33 (49.3)
Ascitis No, %	48 (71.6)
Hemorragia variceal No, %	39 (58.2)
Lesión renal No, %	25 (37.3)
Peritonitis bacteriana espontánea No, %	8 (11.9)
Carcinoma hepatocelular No, %	7 (10.4)
Leucocitos totales, media, DE	7630 ± 4417

Characteristics of patients with lymphopenia and cirrhosis

Age, mean, SD	58.12 ± 10.92
Gender
Woman, No, %	39 (58.2)
Man, No, %	28 (41.8)
Child-Pugh-Turcotte
A, No, %	5 (7.5)
B, No, %	32 (47.8)
C, No, %	30 (44.8)
Admission diagnosis
Variceal hemorrhage, No, %	29 (43.3)
Acute on chronic liver failure No, %	13 (19.4)
Liver encephalopathy No, %	8 (19.4)
Acute kidney injury No, %	8 (19.4)
Mortality No, %	12 (17.9)
Lymphopenia
<1000 absolutes lymphocytes No, %	35 (52.2)
Comorbidities No, %	52 (76.6)
MELD 3.0, mean, SD	21±9
Liver encephalopathy No, %	33 (49.3)
Ascites No, %	48 (71.6)
Variceal hemorrhage No, %	39 (58.2)
Acute kidney injuryNo, %	25 (37.3)
Spontaneous bacterial peritonitis No, %	8 (11.9)
Hepatocellular carcinomaNo, %	7 (10.4)
Absolutes lymphocytes, mean, DE	7630 ± 4417