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Preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients
Xian-Jun Xia1, Bao-Chi Liu, Jin-Song Su
1Department of Surgery, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai, PR China.
Background:
CD4 count or CD4/CD8 ratio has been found to be a valuable marker of disease progression in HIV and AIDS. Our objective was to evaluate preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations.
Methods:
Retrospective analysis of 35 HIV-infected patients (four females, 31 males) undergoing abdominal operations. All patients were divided into postoperative sepsis group (A) and non-sepsis group (B). Demographic and clinical information were entered into a database and included: type of surgical procedure, age, peripheral blood cells, plasma albumin, CD4 counts, and CD4/CD8 ratios. Furthermore, we stratified and compared the incidence of postoperative sepsis according to the preoperative CD4 counts with breakpoint value of 200 cells/μL and preoperative CD4/CD8 ratios with breakpoint value of 0.15.
Results:
Overall postoperative sepsis morbidity in our study was 51.43% (18/35). In sepsis group, the mean preoperative and postoperative CD4 counts, CD4/CD8 ratios, and postoperative platelet count were found significantly lower, respectively, than those in non-sepsis group (P < 0.05). The incidence of postoperative sepsis in the patients with preoperative CD4 counts ≤ 200 cells/μL was markedly higher than those with CD4 counts > 200 cells/μL (83.3% versus 17.65%; P = 0.000). Likewise, the incidence of postoperative sepsis in the patients with preoperative CD4/CD8 ratios ≤ 0.15 was dramatically higher than those with CD4/CD8 ratios > 0.15 (90% versus 36%; P = 0.007).
Conclusions:
Our preliminary study showed that HIV-infected patients with preoperative CD4 count ≤ 200 cells/μL or CD4/CD8 ratio ≤ 0.15 had overall higher postoperative sepsis morbidity. Preoperative CD4 count or CD4/CD8 ratio may be used as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations.
