A leukocyte score to improve clinical outcome predictions in bacteremic pneumococcal pneumonia in adults.
BACKGROUND
Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial.


METHODS
All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (<1500 cells/mm(3)), lymphopenia (<400), and monocytopenia (<200).


RESULTS
One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35-16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P < .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level.


CONCLUSIONS
This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.
Département d'Infectiologie.
Mathieu
M
Blot
Département d'Infectiologie.
Delphine
D
Croisier
Laboratoire de Bactériologie, Plateau Technique de Biologie ; Observatoire Régional du Pneumocoque, Bourgogne.
André
A
Péchinot
Service de Pneumologie et de Réanimation Respiratoire.
Ameline
A
Vagner
Département d'Infectiologie.
Alain
A
Putot
Département d'Infectiologie.
Aurélie
A
Fillion
Service de Pneumologie et de Réanimation Respiratoire.
Nicolas
N
Baudouin
Service de Réanimation Médicale ; Centre d'Investigation Clinique-Epidémiologie Clinique/Essais Cliniques , Centre Hospitalier Universitaire , Dijon , France ; Institut National de la Santé et de la Recherche Médicale, Dijon , France.
Jean-Pierre
JP
Quenot
Service de Réanimation Médicale.
Pierre-Emmanuel
PE
Charles
Service de Pneumologie et de Réanimation Respiratoire.
Philippe
P
Bonniaud
Département d'Infectiologie.
Pascal
P
Chavanet
Département d'Infectiologie.
Lionel
L
Piroth
Streptococcus pneumonia; bacteremia; leukocyte; mortality; pneumonia