Lymphopenia and poor performance status as major predictors for infections among residents in long-term care facilities (LTCFs): A prospective cohort study

The main aim of this study was to investigate the risk factors and consequence of LTCFs-acquired infections in Taiwan through a 16-month follow-up. This prospective cohort study invited residents of 10 private LTCFs in Taipei for study. For each participant, Karnofsky Performance Scale (KPS), use of feeding tube and/or urinary catheters, serum levels of albumin, total cholesterol, complete blood count, occurrence of LTCF-acquired infections, all-cause mortality were recorded. Overall, a total of 198 LTCF residents entered the study for a total of 67,395 resident-days, and 156 participants (79.8 ± 9.7 years, 51.3% males) complete the follow-up with a total of 67,395 resident-days. During the study period, 360 LTCF-acquired infections occurred, and the incidence was estimated to be 5.34 episodes per 1000 resident-days. Subjects with LTCF-acquired infections were more likely to die than those without infections. Besides, subjects with lymphopenia and long-term use of feeding tube and/or urinary catheters were significant risk factors for LTCF-acquired infections. However, poorer functional status and occurrence of lower respiratory tract infections were significant predictive factors for all-cause mortality. In conclusion, the period prevalence of LTCF-acquired infections was higher in Taiwan than previous reports, but the incidence was similar. In addition to traditional risk factors, lymphopenia, a surrogate indicator for immunosenescence, was a significant risk factor for LTCF-acquired infections.