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Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 19 / No. 3 / Published : 2013-01

TOC : 8, and page :178 - 184

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Original Article :

(cd4+ t lymphocyte as a prognosis predictor in sepsis patients)

Author :

  1. Lestari Ekowati*1
  2. Aryati*2
  3. Hardiono*3
  1. Laboratorium Kesehatan Daerah Kota Mojokerto
  2. Departemen Patologi Klinik FK UNAIR/RSUD Dr. Soetomo Surabaya
  3. Departemen Anestesiologi dan Reanimasi FK UNAIR/RSUD Dr. Soetomo Surabaya

Abstract :

Sepsis is the most common cause of ICU mortality in USA. Mortality of sepsis in developing countries is still very high, about 50-70% and has became a 80% incidence in septic shock. There was a decrease of CD4+ T lymphocyte count in patients with sepsis caused by apoptosis indicating septic patients suffered from immune functional impairment. CD4+ T lymphocyte count can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively. Eighty eight (88) patients who met sepsis criteria were studied. The researchers collected clinical variables of all patients within 24 hours diagnosis of sepsis, and calculated APACHE II score. At the same time, blood sample were taken to measure the CD4+ T lymphocyte count. The data were analyzed using independent Student-T-test and ROC curve was used for prognosis. There is a significant difference in CD4+ T lymphocyte count between non survival and survival group (non survival group 203±178 cells/µL, survival group 442±303 cells/µL, p<0.001), and the percentage of CD4+ T lymphocyte (non survival group 25.05±11.55%, survival group 34.38±9.15%, p<0.001). There is an under ROC curve for CD4+ T lymphocyte count was 0.81, and for the percentage of CD4+ T lymphocyte was 0.748. Cut off value for CD4+ T lymphocyte count was 204 cells/µL, and the percentage of CD4+ T lymphocytes was 25.23%. Based on this study, the CD4+ T lymphocyte count can be used as a predictor of prognosis in sepsis patients.       Sepsis merupakan penyebab kematian di ICU yang terbanyak di USA. Angka kematian sepsis di negara berkembang masih sangat tinggi, sekitar 50-70% dan menjadi 80% di renjatan septik. Penurunan jumlah limfosit T CD4+ terjadi di pasien sepsis yang disebabkan karena apoptosis. Hal ini menunjukkan bahwa pada di yang mengalami sepsis terjadi gangguan fungsi kekebalan tubuh. Beberapa telitian menyebutkan bahwa jumlah limfosit T CD4+ dapat menggambarkan derajat keparahan sepsis dan meramalkan perjalanan penyakit penderita secara tepat guna. Lima puluh tiga penderita sepsis diikutkan/disertakan dalam penelitian ini. Data klinis dari semua penderita dikumpulkan dalam 24 jam setelah diagnosis sepsis ditetapkan dan angka APACHE II dihitung. Sampel darah diambil untuk diperiksa jumlah limfosit T CD4+-nya. Analisis data dilakukan dengan menggunakan uji t independen dan kurva ROC dipakai untuk mengetahui perjalanan penyakit. Hasilnya diketahui bahwa didapatkan perbedaan yang bermakna antara jumlah limfosit T CD4+ kelompok yang bertahan hidup dan yang tidak (kelompok bertahan hidup 516±339 sel/µL, kelompok tidak bertahan hidup 197±165 sel/µL, p<0,001), demikian pula dengan persentase limfosit T CD4+ (kelompok bertahan hidup 34,15±10,78%, kelompok tidak bertahan hidup 24,67±12,31%, p=0,004). Luas area di bawah kurva ROC untuk jumlah limfosit T CD4+ adalah 0,87, dan untuk persentase limfosit T CD4+ adalah 0,734. Nilai titik potong limfosit T CD4+ adalah 204 sel/µL, dan untuk persentase limfosit T CD4+ adalah 21,56%. Jumlah limfosit T CD4+ dapat digunakan sebagai peramal perjalanan penyakit penderita yang mengalami sepsis.

Keyword :

Sepsis, CD4+ T lymphocytes, prognosis,


References :

  1. Hotchkiss RS, Karl IE, (2003). The Pathophysiology and Treatment of Sepsis. New England : The New England Journal of Medicine
  2. Kresno SB, (2009). Aspek Biologi Molekuler Sepsis. Jakarta : Departemen Patologi Klinik Fakultas Kedokteran Universitas Indonesia
  3. Widodo U, (2008). Profil pasien yang didiagnosis sepsis di bangsal penyakit dalam RS Dr Sardjito tahun 2008. Yogyakarta : Universitas Gadjah Mada. RS Sardjito
  4. Hadi U, Triyono EA, (2010). Medical Audit of The Management of Patients with Sepsis in The Intermediate Care Unit of Departement Internal Medicine School of Medicine Airlangga University Dr Soetomo Hospital. Surabaya : Indonesian Journal of Tropical and Infectious Diseases
  5. Lee KH, Hui TKL, Tan WC, (1993). Acute Physiology and Chronic Health Evaluation (APACHE II) Scoring in the Medical Intensive Care Unit, National University Hospital, Singapore. Singapore : Singapore Med J


   


Archive Article

Cover Media Content

Volume : 19 / No. : 3 / Pub. : 2013-01
  1. {(active caspase-3 in acute myeloid leukaemia (aml) and acute lymphoblastic leukaemia (all)}
  2. (principle modification of β-glucan detection from candida albicans in serum)
  3. Apoptosis index between females and males in regular hemodialysis
  4. [iron deficiency in pregnant women by haemoglobin reticulocyte (ret-he)]
  5. (higher level of ctx in osteoporotic women compared to normal and osteopenic women)
  6. (cystatin c, hba1c and albumin creatinine ratio)
  7. (lactate dehydrogenase (ldh) during storage)
  8. (cd4+ t lymphocyte as a prognosis predictor in sepsis patients)
  9. (angiotensin ii on adipocytes culture exposed with high glucose)
  10. (the panleucogating method for lymphocyte cd4 counting in hiv patients)
  11. (c3c serum complement and blood t-cd4+ lymphocyte)
  12. (cell based hemostatis – in vivo)
  13. Neonatal acute myeloid leukaemia