       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).

