       Document 0735
 DOCN  M9630735
 TI    Alterations in lymphocyte subsets as prognosticators of postoperative
       infections.
 DT    9603
 AU    Gennari R; Dominioni L; Imperatori A; Bianchi V; Maroni P; Dionigi R;
       Department of Surgery, University of Pavia in Varese, Ospedale;
       Multizonale, Italy.
 SO    Eur J Surg. 1995 Jul;161(7):493-9. Unique Identifier : AIDSLINE
       MED/96026958
 AB    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%.
 DE    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

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

