Liu Baochi Shanghai Public Health Clinical Center affiliated to Fudan University Classify and Risk Analysis of Surgical patients with HIV infection.

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Presentation transcript:

Liu Baochi Shanghai Public Health Clinical Center affiliated to Fudan University Classify and Risk Analysis of Surgical patients with HIV infection

HIV-infected patients undergoing surgeries have high postoperative risk of sepsis. It is therefore critical to understand the risks of sepsis corresponding to various surgery-based diseases. BACKGROUND

All patients with a preoperative diagnosis of HIV positivity who underwent an abdominal operation from January 1997 to December 2007 were analyzed. 77 operation with 42cases （ 55% ） postoperative complications ， 23died(30% ）

780,000 HIV infected by the end of 2011

Shanghai Publical Health Clinical Center

Object To explore the classify and risk analysis of surgical patients with HIV-infection in China.

Retrospective analysis the clinical data of 803 HIV-infected patients who have been operated at Shanghai Public Health Clinical Center and at Henan Infectious Hospital from January 2011 to February Methods

The patients were divided into sepsis and no- sepsis group. Then divided into infection, dysfunction, tumor and the trauma group respectively. The patients CD4, CD8, CD4/CD8, WBC, Plate, Hemogloubin were compared. Methods

Indicators BS.E,WalsSig.Exp (B) EXP(B) ‘s 95% C.I. LowUp Dysfunction Infection Tumor Trauma WBC(×10 9 /L,bef) Hemoglobin(g/L,bef) Protein(g/L,bef) CD4(cells/µl,bef) CD8(cells/µl,bef) CD4CD8Ratio(bef) Constant Logistical regression of risk factors before operation (different operation type)

variableSepsisNon-SepsisMann-Whitney U ValueP Value CD4 （ cell/ul ） 178.0[11.0, 608.3] a 284.5[30.0, 628.4] CD8 （ cell/ul ） 611.0[179.9, ]674.0[243.5, ] CD4/CD80.27[0.04, 0.92]0.39[.97] WBC(x10 9 /L )5.0[2.3, 11.0]5.0[2.6, 10.0] Hb （ g/L ） 123.0[72.6, 156.6]131.0[77.7, 157.0] Plat(x10 9 /L )183[60.4,428.8]178.0[89.3, 336.0] Results

17 cases died within 30 day after operation (mortality 2.11%). The patent’s CD4, CD8, CD4/CD8, Plate, Hemoglobin was significantly lower in sepsis group compare with in no sepsis group. Results

Trauma group variable SepsisNon-Sepsis Mann- Whitney U Value P Value CD4 （ cell/ul ） 333.0[77.0, 931.0] a 298.0[135.0, 643.0] CD8 （ cell/ul ） 728.0[294.0, ] 421.0[276.0, 584.0] CD4/CD8 0.43[0.13, 1.89] 0.86[0.32, 1.36] WBC(x10 9 /L ) 6.3[3.3, 12.1]6.5[3.4, 15.8] Hb （ g/L ） 116.5[88.0, 138.0] 121.3[78.3, 141.0] Plat(x10 9 /L ) 175.5[58.0, 446.0] 201.0[103.0, 251.0] Trauma group 57 cases(7%) ， 24 developed sepsis ， morbidity 38% ， no died.

Tumor group variable SepsisNon-SepsisMann-Whitney U ValueP Value CD4 （ cell/ul ） 151.5[5.5, 564.7] a 219.0[10.3, 674.4] CD8 （ cell/ul ） 562.0[95.6, ]607.5[143.0, ] CD4/CD8 0.27[0.01, 2.20]0.32[0.03, 0.95] WBC(x10 9 /L ) 4.7[3.1, 7.9]5.3[3.1, 10.9] Hb （ g/L ） 124.0[71.8, 149.7]128.0[67.0, 154.5] Plat(x10 9 /L ) 174.5[58.8, 348.0]171.0[91.0, 363.5] Tumor group 225 cases(28%) ， 103 developed sepsis. morbidity 46% ， 9 died of severe sepsis.

Infection group variableSepsis Non- Sepsis Mann- Whitney U Value P Value CD4 （ cell/ul ） 159.0[7.6, 712.3] a 276.0[21.8, 569.5] CD8 （ cell/ul ） 611.0[165. 5, ] 709.0[248. 8, ] CD4/CD8 0.22[0.04, 0.99] 0.43[0.13, 1.89] WBC(x10 9 /L ) 5.4[2.8, 11.8] 6.3[3.3, 12.1] Hb （ g/L ） 122.0[62.4, 154.1] 116.5[88.0,138.0] Plat(x10 9 /L ) 211.0[64.4,476.1] 183.0[105. 6, Infecton group 345 cases(43%) ， 145 developed sepsis ， morbidity 42% ， 8 cases died of abdomen absis and severe sepsis.

Disfunction group Disfunction group 176 cases(22%) 。 46 developed sepsis(mortality 25.4%) ， no died. Treating AIDS patients with decompensated liver cirrhosis by autologous bone marrow transfusion variableSepsisNon-SepsisMann-Whitney U ValueP Value CD4 （ cell/ul ） 179.0[9.6, 660.4] a 343.0[102.2, 720.0] CD8 （ cell/ul ） 546.0[223.4, ]783.0[247.5, ] CD4/CD80.27[0.03, 1.20]0.44[.95] WBC(x10 9 /L )4.7[1.8, 13.9]4.9[2.1, 10.2] Hb （ g/L ） 134.0[68.1, 168.8]127.0[61.0, 171.0] Plat(x10 9 /L )160[40.3,423.5]164.0[56.0, 352.0]

AIDS with TB intestinal abstruction ， CD4 only 1 cell/ul.Part intestin resection and ileum fistul.6 months after operation,CD4 incresed to 20 cell/ul.One month after second operation of enclosed ileum fistul and autologous bone marrow transfusion,CD4 increased to 54 cell/ul.2 months CD4 increased to 70 cell/ul. Treating AIDS patients by autologous bone marrow transfusion

6 month after second operation of enclosed ileum fistul and autologous bone marrow transfusion,CD4 increased to 168 cell/ul.There is no virus load. This advanced AIDS patient is clinical cured.

1.The lower CD4,CD8,CD4/CD8,WBC,Plate and Hemoglobin are risk facts of postoperative sepsis. 2.Prevention of occupational expose and treatment after occupational expose is very important 3.HIV-infected patients are more likely to get postoperative infectious complications Rational treatment can reduce the rate of postoperative infection. Conclusion