ABSTRACT
Background: Extubating failure due to severe pneumonia increases morbidity and mortality. Systemic adaptive immunity, T lymphocyte cells CD4/CD8 in blood, has special role as a mortality predictor in severe pneumonia. Further study still needed to evaluate local adaptive immunity through bronchoalveolar lavage cellular examination in both lungs.
Objective: The aim of this study was to find out the differences between T lymphocytes CD4/CD8 in both lungs based on extubating status and mortality status.
Methods: We performed a cohort prospective study of 40 patients with severe pneumonia whom underwent endotracheal intubation and bronchoscopy hospitalized in intensive care unit between November 2020 to January 2021 in Dr. Cipto Mangunkusumo National General Hospital. Primary data was taken and analyzed using univariate and bivariate to investigate mean or median differences with unpaired t-test for normal numeric distribution data and Mann-Whitney test for abnormal distribution numeric data.
Result: The proportion of extubating failure was 80% and mortality rate was 75%. There were significantly different results of BALF CD4 T cells lymphocyte fraction in severe pneumonia group of patients based on extubating status (p=0,006) and mortality status (p=0,002). Blood CD4 T cells lymphocyte fraction and blood CD4/CD8 T cells lymphocyte ratio were found significantly higher in the successfully extubating group of patients compared to extubating failure group of patients; and also, significantly higher in survived group of patients compared to mortality group of patients with pneumonia severe.
Conclusion: Fraction of CD4 BALF in severely injured pneumonia lungs group of patients who had successful intubation processes were statistically different compared to the group of patients with unsuccessful extubating. Fraction of CD4 BALF were also found statistically different in the group of patients who were survived compared to the group of patients who were passed away.
Key Words: Local Adaptive Immunity; Subset T Lymphocyte; CD4 cells; CD8 cells; Bronchoalveolar Lavage; Extubating failure; Severe Pneumonia