CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus

Objective: To measure the prognostic utility of helper T-cell (CD4) counts in human immunodeficiency virus (HIV)-infected patients undergoing major abdominal surgery. Design: Retrospective case series. Setting: Three university-affiliated hospitals. Patients: Forty-three HIV-infected patients undergoing major abdominal surgery. Main Outcome Measures: Morbidity and mortality rates with respect to CD4 cell counts. Results: Nineteen of 32 patients who had CD4 cell counts less than 0.20X10(9)/L (200 cells/mu L) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20X10(9)/L (200 cells/mu/L) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20X10(9)/L, and was 9% for those with CD4 cell counts greater than 0.20X10(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 intraabdominal 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, 0.034X10(9)/L) than those without complications (median,0.102X10(9)/L) (P=.02). Similarly, patients who died had lower CD4 cell counts (median, 0.031X10(9)/L vs 0.088X10(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 0.20X10(9)/L (200 cells/mu L). A perioperative septic process and HIV-related pathologic conditions seen at laparotomy are also associated with worse outcomes.