Author/Authors :
Mwanje, Arthur Kavuma Department of Anaesthesia - Makerere University, Kampala, Uganda , Ejoku, Joseph Department of Anaesthesia - Uganda Heart Institute, Kampala, Uganda , Ssemogerere, Lameck Department of Anaesthesia - Makerere University, Kampala, Uganda , Lubulwa, Clare Department of Anaesthesia - Mulago National Referral Hospital - Kampala, Uganda , Namata, Christine Department of Anaesthesia - Makerere University, Kampala, Uganda , Kwizera, Arthur Department of Anaesthesia - Makerere University, Kampala, Uganda , Wabule, Agnes Department of Anaesthesia - Makerere University, Kampala, Uganda , Okello, Erasmus Department of Anaesthesia - Makerere University, Kampala, Uganda , Kizito, Samuel Department of Clinical Epidemiology and Biostatistics - Makerere University, Kampala, Uganda , Lubikire, Aggrey Department of Anaesthesia - Makerere University, Kampala, Uganda , Sendagire, Cornelius Department of Anaesthesia - Uganda Heart Institute, Kampala, Uganda , Biraro, Irene Andia Medical Research Council - Uganda Virus Research-Institute Uganda Research Unit on AIDS, Kampala, 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.
