EP.FRI.840 Lymphopaenia and laparotomy – a predictor of mortality

Aims Immune dysfunction is often seen in patients undergoing emergency laparotomy. Efforts to correct T-cell dysfunction & apoptosis by use of immune checkpoint inhibitors in prospective trials are underway, where lymphopaenia is an indication for therapy. We investigated the association of lymphopaenia in patients undergoing emergency laparotomy as a measure of immune dysfunction and predictor of 30-day mortality.  Methods Retrospective analysis was performed on emergency laparotomies at the Royal Alexandra Hospital using the prospectively maintained Emergency Laparotomy and Laparoscopic Scotland Audit (ELLSA) database. White cell count (WCC), Neutrophil count, Lymphocyte count and C-reactive protein (CRP) were compared between those who died within 30 days and those who survived using Mann-Whitney-U test (p < 0.05). Results Between 2017-2018, 196 cases were analysed for assessed, after 4 patients excluded due to insufficient data. Mean age was 63 years, 86 were male and 108 were female. Eighteen (9.2%) deaths were recorded within 30 days of emergency laparotomy. Non-survivors demonstrated a decreased lymphocyte count on day 3 and 7 following emergency laparotomy when compared to the survivor group (p < 0.05). No significance was found when comparing the WCC, Neutrophil count or CRP of both groups. Conclusions Patients who did not survive emergency laparotomy were found to have decreased lymphocyte counts when compared with survivors.  This may be a surrogate measure of sepsis or trauma-associated immune dysfunction. Further study into immune related mechanisms may lay the foundation for prospective studies using immune checkpoint inhibitors in the emergency laparotomy population.