Situación inmune en el anciano con neumonía durante el episodio agudo y tras el alta / Immune status in the elderly with pneumonia during the acute episode and after discharge

RESUMEN

Objetivo: analizar la situación inmunológica básica de la neumonía en el anciano (NEA) durante el ingreso y a los 6 meses tras el alta, y su relación con la mortalidad. Material y métodos: estudio prospectivo en pacientes mayores de 65 años con NEA que ingresaron en el Servicio de Medicina Interna en el Hospital Virgen del Camino (Pamplona) en 2 años. Se estudian los datos epidemiológicos, clínicos, etiológicos, analíticos y antropométricos en el ingreso, y la evolución de la NEA al año del alta. Se determinan linfocitos totales, linfocitos T CD4, CD8, CD4/CD8, inmunoglobulinas, complemento (C3, C4, CH50), anticuerpos antinucleares (ANA), factor reumatoide e interleucina 6 (IL-6) en sangre periférica, así como multitest durante el ingreso. A los 6 meses del alta se estudian linfocitos totales, linfocitos T, CD4, CD8, CD4/CD8 e IL-6. Para realizar las comparaciones entre los diversos parámetros, se aplica un nivel de significación de p < 0,05. Resultados: en el período estudiado se admitió a 125 pacientes con una edad media de 77,9 años (65-95). Fallecieron 11 pacientes (8,8%) durante el ingreso. En el seguimiento ambulatorio durante un año falleció un 30%. Los pacientes que fallecieron tuvieron menos linfocitos totales (p = 0,01), linfocitos T (p = 0,005), CD4 (p = 0,002), C3 (p = 0,001) y C4 (p = 0,001) que los que sobrevivieron. Los ANA estaban presentes en mayor proporción entre los fallecidos (p = 0,017). No se encontraron relaciones evidentes entre los parámetros inmunológicos estudiados y la mortalidad ambulatoria. Los linfocitos totales, linfocitos T, CD4 y los CD8 se recuperan significativamente a los 6 meses tras el alta. En cambio, los valores de IL-6 disminuyen a los 6 meses respecto al ingreso (p = 0,009). Conclusiones: las variables relacionadas con mayor mortalidad durante la NEA fueron linfocitos totales, linfocitos T, CD4, CD8, C3, C4 y ANA. Se describe un aumento significativo de los valores de inmunidad celular a los 6 meses del alta

ABSTRACT

Objective: to analyze immune status in elderly patients with pneumonia during admission and at 6 months after discharge, as well as its association with mortality. Material and methods: we performed a prospective study in patients aged > 65 years old with pneumonia admitted to the Internal Medicine Department of the Hospital Virgen del Camino (Pamplona) over a 2-year period. Epidemiological, etiological, laboratory and anthropometric data were studied at admission and 1 year after discharge. Total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, immunoglobulins, complement (C3, C4, CH50), antinuclear antibodies (ANA), rheumatoid factor and interleukin-6 (IL-6) in peripheral blood, as well as the multitest during admission, were studied. The following variables were studied 6 months after discharge total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, and IL-6. For the comparison of variables, a significance level of p < 0.05 was set. Results: during the study period, 125 patients with a mean age of 77.9 years (65-95) were admitted. Eleven patients (8.8%) died during admission. During the 1-year outpatient follow-up, 30% died. Patients who died had lower total lymphocyte (p = 0.01), T lymphocyte (p = 0.005), CD4 (p = 0.002), C3 (p = 0.001) and C4 (p = 0.001) levels than those who survived. Higher ANA concentrations were found among patients who died (p = 0.017). No clear associations were found between the immunological parameters studied and outpatient mortality. Levels of total lymphocytes, T lymphocytes, CD4 and CD8 were significantly increased at 6 months after discharge. In contrast, IL-6 levels were lower at 6 months after discharge than on admission (p = 0.009). Conclusions: the variables related to higher mortality in pneumonia in the elderly were total lymphocytes, T-lymphocytes, CD4, CD8, C3, C4 and ANA. Values of cellular immunity were significantly increased 6 months after discharge