The Value Of Peripheral Blood Lymphopenia To Forecast Spontaneous Intracerebral Hemorrhage Associated Pneumonia At The Early Stage

Objective:Spontaneous cerebral hemorrhage associated pneumonia(sICHAP),one of the most common complications of spontaneous cerebral hemorrhage(sICH),is thought to be affected by immunodepression.In this research we assumed that sICHAP was related to the early lymphopenia,resulting in microecology changes in the airway flora and promoting the exacerbation of pneumonia.Methods:1.We enrolled in sICH patients from January 2018 to December 2019 in the Neurosurgery Intensive Care Unit of Tianjin Medical University General Hospital.The patients were divided into pulmonary infection group(PG)and non-pulmonary infection group(NPG).The absolute value of lymphocytes on 4th day(D4L)was compared between the two groups,and the factors related to sICHAP were analyzed.The patients were further divided into low and high groups according to the cut-off value of D4L,and the short-term prognosis were analyzed between the groups.2.sICH patients admitted to the same center from January 2019 to February 2020 were screened and enrolled.Peripheral blood was collected to detect the lymphocyte subsets and cytokines at 4th day.When sICHAP was diagnosed,the patient was included in the pulmonary infection group(LSPG),otherwise in the non-lung infection group(LSNPG).The difference of lymphocyte subsets and cytokines between the two groups were compared.3.The sICH patients admitted to the same part from January 2016 to December 2018 were screened and enrolled.We collected and devided the sputum sample into two parts,one for the sputum culture(CulG)and the other was stored.When CulG within 48 hours did not report any pathogenic bacteria,the stored sample was included as pre-infection group(PreG)sample library,otherwise excluded.When considering the diagnosis of sICHAP accompanied with D4L<1000 ×106/L,the CulG after 48 hours was positive,and the stored sample was included as genetic group(GenG)sample.All the GenG and chosen PreG samples were send to the genetic testing company for 16Sr RNA genetic testing by single-blinding method.We assessed the consistency between CulG and GenG,and analyzed the difference in the airways microecological composition of patients accompanied with D4L reduction between PreG and GenG samples.Results:1.A total of 178 cases(PG 134,NPG 44)were included in this part.sICHAP occured in 2.5(2,4)days.There was a significant decrease of D4L in PG(P<0.05).D4L reduction was a protective factor of sICHAP(P<0.05),with an OR value of 0.412(95%CI=0.192-0.885).Area under curve of D4L was 0.75(95%CI was 0.669-0.824),the cut-off value was 0.805×109/L(sensitivity 90.9%,specificity 49.3%).The high D4L group(D4L>0.8×109/L,n=111)had higher GOS(P<0.001).2.In this part,30 cases were included(LSPG 20,LSNPG 10).sICHAP occured in 2(2,3)days.There was a significant decrease of D4L in the LSPG group,especially the proportion of the cytotoxic T cells(CD8+T cells,Ts)(P<0.05).The difference of the ratio of helper T cells(CD4+T cells,Th)to Ts(Th/Ts)was statistically significant(P<0.05).The absolute values of Th,Ts,BL,NK and Treg decreased significantly in the LSPG group(P<0.05).Il-6 and Il-10 were significantly increased in LSPG(P<0.05).3.In this part,12 cases infected(3 by Acinetobacter baumannii,1 by Klebsiella,3 by Klebsiella and 5 by Pseudomonas)were enrolled,including 9 males.Five PreG samples of Pseudomonas aeruginosa were selected.All 12 GenG samples were consistent with the CulG reports at the level of the genera of the phylum.Pseudomonas aeruginosa y-Pseudomonas-Pseudomonasceae infection was increased significantly(P<0.05)in the five GenG compare with relevant PreG.The percentages of Lactobacillus-Streptococci-Streptococcus and Pasteurella-Pasteuridae-Hemophilus significantly decreased in GenG samples(P<0.05);the percentage of Neisseria order-Neisseriaceae-Neisseria genus was significantly increased in GenG samples(P<0.05).Conclusion:D4L was an independent protective predictor of sICHAP,and D4L<0.8×109/L could be used as a high-risk predictive indicator.Lymphocyte subsets in peripheral blood declined on the 4th day,especially cytotoxic T cells,suggesting that sICHAP may be related to the decline of patients’ immune function.16S rRNA could be used reliably to confirm the airway microecology of sICHAP patients.sICHAP may occur within the 48 hours in the sICH patients accompanied with D4L reduction.