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1996-02-26
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Document 0708
DOCN M9620708
TI T-lymphocyte subsets in acute illness.
DT 9602
AU Feeney C; Bryzman S; Kong L; Brazil H; Deutsch R; Fritz LC; Department
of Internal Medicine, Highland General Hospital,; Oakland, CA
94602-1018, USA.
SO Crit Care Med. 1995 Oct;23(10):1680-5. Unique Identifier : AIDSLINE
MED/96019887
AB OBJECTIVES: To determine the range of T-lymphocyte subsets (CD4, CD8,
and CD4/CD8 ratios) in acutely ill, hospitalized patients and to
determine whether these concentrations correlate with illness severity,
survival rate, or immunodepression. DESIGN: Cross-sectional study,
comparing Acute Physiology and Chronic Health Evaluation II (APACHE II)
scores and the calculated, disease-specific, predicted mortality rate
with T-lymphocyte subsets. SETTING: Urban county hospital intensive care
unit (ICU), serving as the designated trauma center. PATIENTS: One
hundred two consecutively admitted ICU patients (72 medical and 30
surgical). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient
clinical data, APACHE II scores, and their associated predicted
mortality rate were recorded. Blinded human immunodeficiency virus (HIV)
and lymphocyte testing was performed on samples from all patients on ICU
admission. Despite only three (2.9%) of 102 patients testing positive
for HIV antibodies, 41% (42/102) of patients had CD4 concentrations of <
400 cells/microL, and 29% (29/102) had CD4 concentrations of < 300
cells/microL. Mean CD8 concentrations were even lower, compared with
normal laboratory values, resulting in a slight increase in CD4/CD8
ratios, although 16% (16/102) of patients had a CD4/CD8 ratio of < 1.
CD4 counts were linearly related to total lymphocyte concentrations
(Pearson correlation coefficient = 0.948), but no relationship was found
between total lymphocyte or lymphocyte subset counts and APACHE II
score, predicted mortality rate, or survival rate. CONCLUSIONS: Acute
illness alone, in the absence of HIV infection, can be associated with
profound decreases of T-lymphocyte populations. This problem is
unpredictable and does not correlate with severity of illness, predicted
mortality rate, or actual mortality rate. No conclusions regarding HIV
serostatus or survival can be made based on single measurements of
T-cell concentrations in acutely ill hospitalized patients.
DE Acquired Immunodeficiency Syndrome/IMMUNOLOGY *Acute Disease Adult
Aged Aged, 80 and over APACHE Comparative Study Cross-Sectional
Studies CD4-CD8 Ratio Female Human Intensive Care Units Male
Middle Age Mortality Predictive Value of Tests Support, Non-U.S.
Gov't *T-Lymphocyte Subsets JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).