Admission Lymphopenia Predicts Infectious Complications and Mortality in Traumatic Brain Injury Victims

Shock. 2022 Feb 1;57(2):189-198. doi: 10.1097/SHK.0000000000001872.


Background: Traumatic brain injury (TBI) is a major cause of mortality and disability associated with increased risk of secondary infections. Identifying a readily available biomarker may help direct TBI patient care. Herein, we evaluated whether admission lymphopenia could predict outcomes of TBI patients.

Methods: This is a 10-year retrospective review of TBI patients with a head Abbreviated Injury Score 2 to 6 and absolute lymphocyte counts (ALC) collected within 24 h of admission. Exclusion criteria were death within 24 h of admission and presence of bowel perforation on admission. Demographics, admission data, injury severity score, mechanism of injury, and outcomes were collected. Association between baseline variables and outcomes was analyzed.

Results: We included 2,570 patients; 946 (36.8%) presented an ALC ≤1,000 on admission (lymphopenic group). Lymphopenic patients were significantly older, less likely to smoke, and more likely to have heart failure, hypertension, or chronic kidney disease. Lymphopenia was associated with increased risks of mortality (OR = 1.903 [1.389-2.608]; P < 0.001) and pneumonia (OR = 1.510 [1.081-2.111]; P = 0.016), increased LOS (OR = 1.337 [1.217-1.469]; P < 0.001), and likelihood of requiring additional healthcare resources at discharge (OR = 1.669 [1.344-2.073], P < 0.001). Additionally, lymphopenia increased the risk of early in-hospital death (OR = 1.459 [1.097-1.941]; P = 0.009). Subgroup analysis showed that lymphopenia was associated with mortality in polytrauma patients and those who presented with two or more concurrent types of TBI. In all subgroup analyses, lymphopenia was associated with longer length of stay and discharge requiring higher level of care.

Conclusion: A routine complete blood count with differential for all TBI patients may help predict patient outcomes and direct care accordingly.

MeSH terms

  • Adult
  • Aged
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / mortality
  • Cohort Studies
  • Female
  • Forecasting / methods*
  • Hospitalization / statistics & numerical data
  • Humans
  • Infections / epidemiology
  • Infections / etiology
  • Infections / mortality*
  • Injury Severity Score
  • Iowa
  • Lymphopenia / blood
  • Lymphopenia / complications*
  • Male
  • Middle Aged
  • Mortality / trends
  • Registries / statistics & numerical data
  • Retrospective Studies