Alterations in lymphocyte subsets as prognosticators of postoperative infections.

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Alterations in lymphocyte subsets as prognosticators of postoperative infections.

Eur J Surg. 1995 Jul;161(7):493-9. Unique Identifier : AIDSLINE MED/96026958
Gennari R; Dominioni L; Imperatori A; Bianchi V; Maroni P; Dionigi R; Department of Surgery, University of Pavia in Varese, Ospedale; Multizonale, Italy.

Abstract: OBJECTIVE: To evaluate changes in lymphocyte subsets after major abdominal and thoracic operations, and to correlate changes with the development of clinically relevant infections postoperatively. DESIGN: Open study. SETTING: University hospital, Italy. SUBJECTS: 33 patients who were to undergo major abdominal or thoracic operations. INTERVENTIONS: Lymphocyte subsets were measured by cytofluorimetry before operation and 1, 3, 5, and 7 days postoperatively. MAIN OUTCOME MEASURES: Correlation between changes in the number of lymphocyte subsets and development of infection. RESULTS: Lymphocyte subsets were within the reference range in all patients before operation. 10/33 Patients developed infections (pneumonia, bacteraemia, or wound or urinary tract infections) between the second and the ninth days postoperatively (30%). On day 1 the numbers of all lymphocyte subsets had decreased significantly compared with the preoperative measurements in all patients (CD3 p < 0.01, CD4 p < 0.001, and CD8 p < 0.05). The reduction in CD3 was significantly greater in the group that developed infections (p < 0.001). Among patients who did not develop infections the numbers of lymphocyte subsets had returned to the reference range within a week of operation whereas among patients who developed infections they remained depressed (p < 0.05). CONCLUSION: The synchronous reduction in numbers of all lymphocyte subsets on the first day postoperatively to below 50% of the reference range (CD3 to < 600/microliters, CD4 to < 400/microliters, and CD8 to < 250/microliters) predicted the development of infection postoperatively with an accuracy of 89%, a sensitivity of 80%, and a specificity of 96%.

Keywords: Adult Aged CD4 Lymphocyte Count Female Human Infection/ETIOLOGY/*IMMUNOLOGY Lymphocyte Count Male Middle Age Postoperative Complications/ETIOLOGY/*IMMUNOLOGY Prognosis Sensitivity and Specificity Surgical Wound Infection/IMMUNOLOGY T-Lymphocyte Subsets/*IMMUNOLOGY T-Lymphocytes/IMMUNOLOGY T-Lymphocytes, Helper-Inducer/*IMMUNOLOGY T-Lymphocytes, Suppressor-Effector/*IMMUNOLOGY CLINICAL TRIAL JOURNAL ARTICLE
960330
M9630747

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