Gurmeet Singh,1 Randhy Fazralimanda,2 Alvina Widhani,3 Juferdy Kurniawan4
1. Dept. of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
2. Dept. of Internal Medicine, Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
3. Dept. of Internal Medicine, Division of Allergy and Immunology, Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
4. Dept. of Internal Medicine, Division of Hepatobilliary and Pancreatic Medicine, Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Abstract

Background: Severe pneumonia is a major health problem in Indonesia and also in the world. The immune system is known to play important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in negative HIV population.
Methods: This study was a prospective cohort study conducted at Cipto Mangunkusumo General Hospital from June to August 2020. The outputs were 30-days survival rate and optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression.
Results: Of the 126 subjects, there was one subject who was lost to follow up. The 30-days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0,651, P=0,01, 95%CI 0,541-0,760, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0,639, P=0,018, 95% CI 0,534-0,744, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2,696 (P=0,008, 95%CI 1.298-5.603), blood CD8 count < 263 cells/μL had a crude HR of 2,133 (P=0,042, 95%CI 1,035-4,392) and adjusted HR of 2,721 (P=0,005, 95%CI 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0,752 (P=0,000, 95%CI 0,662-0,842).
Conclusion: Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. Groups with lower blood CD4 and CD8 count had a higher risk of 30-days mortality.
Keywords: severe pneumonia, CD4 count, CD8 count, 30 days mortality