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Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

ABSTRACT: Background: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of mortality rates as high as 40% among Ugandan critically ill HIV-negative patients, the use of CD4 T cell counts as a measure of the immune status has never been explored among this population. This study assessed the immune status of adult critically ill HIV-negative patients admitted to Ugandan intensive care units (ICUs) using CD4 T cell count as a surrogate marker. Methods: A multicentre prospective cohort was conducted between 1st August 2017 and 1st March 2018 at four Ugandan ICUs. A total of 130 critically ill HIV negative patients were consecutively enrolled into the study. Data on sociodemographics, clinical characteristics, critical illness scores, CD4 T cell counts were obtained at baseline and mortality at day 28. Results: The mean age of patients was 45± 18 years (mean±SD) and majority (60.8%) were male. After a 28-day follow up, 71 [54.6%, 95% CI (45.9-63.3)] were found to have CD4 counts less than 500 cells/mm³, which were not found to be significantly associated with mortality at day 28, OR (95%) 1 (0.4-2.4), p = 0.093. CD4 cell count receiver operator characteristic curve (ROC) area was 0.5195, comparable to APACHE II ROC area 0.5426 for predicting 24-hour mortality. Conclusions: CD4 T cell counts were generally low among HIV-negative critically ill patients. Low CD4 T cells did not predict ICU mortality at day 28. CD4 T cell counts were not found to be inferior to APACHE II score in predicting 24 hour ICU mortality.

SUBMITTER: Kavuma Mwanje A

PROVIDER: S-EPMC6742509 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

Kavuma Mwanje Arthur A Ejoku Joseph J Ssemogerere Lameck L Lubulwa Clare C Namata Christine C Kwizera Arthur A Wabule Agnes A Okello Erasmus E Kizito Samuel S Lubikire Aggrey A Sendagire Cornelius C Andia Biraro Irene I

AAS open research 20190108

<b>Background</b>: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of mortality rates as high as 40% among Ugandan critically ill HIV-negative patients, the use of CD4 T cell counts as a measure of the immune status has never been explored ...[more]

PMID: 31517248

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Project description:IntroductionRecent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients.MethodsWe conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products).ResultsDuring the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score).ConclusionsAdministration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.

Dataset Information

Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

Publications

Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

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