title: Lymphocyte count as a sign of immunoparalysis and its correlation with nutritional status in pediatric intensive care patients with sepsis: A pilot study.
abstract: 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.
  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.
  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.
  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.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.|Hospital Cruz Azul, São Paulo/SP, Brazil.
authors.forename: Talita Freitas
authors.initials: TF
authors.lastname: Manzoli
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Artur Figueiredo
authors.initials: AF
authors.lastname: Delgado
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Eduardo Juan
authors.initials: EJ
authors.lastname: Troster
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Ana Caroline Barreto
authors.initials: AC
authors.lastname: Antunes
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Desirée Mayara
authors.initials: DM
authors.lastname: Marques
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Zamberlan
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000175:diagnosis*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000276:immunology; D009752:Nutritional Status; D010865:Pilot Projects; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D012709:Serum Albumin; D012720:Severity of Illness Index
chemical_list: D012709:Serum Albumin