title: CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus.
abstract: OBJECTIVE
  To measure the prognostic utility of helper T-cell (CD4) counts in human immunodeficiency virus (HIV)-infected patients undergoing major abdominal surgery.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Three university-affiliated hospitals.
  
  
  METHODS
  Forty-three HIV-infected patients undergoing major abdominal surgery.
  
  
  METHODS
  Morbidity and mortality rates with respect to CD4 cell counts.
  
  
  RESULTS
  Nineteen of 32 patients who had CD4 cell counts less than 0.20 X 10(9)/L (200 cells/microL) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20 x 10(9)/L (200 cells/microL) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20 x 10(9)/L, and was 9% for those with CD4 cell counts greater than 0.20 x 10(9)/L (P=.13). Six months postoperatively, mortality rates were 47% and 9%, respectively (P=.03). Of patients with septic processes perioperatively (n=12), mortality was 75%, and was 19% (P=.009) for those with nonseptic processes (n=31). Nine patients had HIV-related intra-abdominal pathologic conditions at laparotomy. Mortality was 56% perioperatively (P=.13) and 88% after 6 months (P=.001). Sixty-eight percent of patients who received blood product transfusions developed complications, whereas only 7% of those who did not receive transfusions developed complications (P<.001). Overall mortality and morbidity rates were 37% and 49%, respectively. Patients with morbidity had lower CD4 cell counts (median, 0.034 x 10(9)/L) than those without complications (median, 0.102 x 10(9)/L) (P=.02). Similarly, patients who died had lower CD4 cell counts (median, 0.031 x 10(9)/L vs 0.088 x 10(9)/L) (P=.05).
  
  
  CONCLUSIONS
  Patients with acquired immunodeficiency syndrome-defining CD4 cell counts undergoing major abdominal surgery developed more complications and had poorer outcomes at 6-month follow-up compared with HIV-infected patients whose CD4 cell counts were greater than 0.20 x 10(9)/L (200 cells/microL). A perioperative septic process and HIV-related pathologic conditions seen at laparotomy are also associated with worse outcomes.
authors.affiliation: Department of Surgery, Wayne State University School of Medicine, Detroit, Mich, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Albaran
authors.forename: J
authors.initials: J
authors.lastname: Webber
authors.forename: C P
authors.initials: CP
authors.lastname: Steffes
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D018791:CD4 Lymphocyte Count; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis