Monitoring significance of CD4+ T lymphocyte count on evaluating frailty status of chronic renal failure in patients

doi:10.3969/j.issn.1004-583X.2022.03.008

Abstract

Abstract:

Objective To evaluate the significance of CD4⁺ T lymphocyte count in the evaluation of nutrition and prognosis of chronic renal failure in patients. Methods Totally 381 chronic renal failure patients were selected from YIDUCLOUD database of the Affiliated Hospital of Qingdao University during 2013 to 2020 for systematic analysis. CD4⁺ T lymphocyte counts and indicators related to immunity and nutrition of those patients were detected on admission, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and frailty score combined with Edmonton Frailty Scale were performed. As CD4⁺ T lymphocytes count of admission, patients were divided into three groups: A group of 67 cases (CD4⁺ T lymphocyte count< 200 cells/μl), B group of 175 cases (200 cells/μl≤CD4⁺ T lymphocyte count <544 cells/μl), and C group of 139 cases (CD4 ⁺ T lymphocyte count≥544 cells/μl). The correlation between CD4⁺ T lymphocyte counts, immune, nutrition-related indicators, SOFA score, APACHE Ⅱ score, and frailty score were analyzed. Kaplan-Meier survival curve was drawn. Results In this study, the overall proportion of frail patients was 36.5%(139/381), the proportion of frail patients was as high as 53.7%(130/242) at the count of CD4 ⁺ T lymphocytes <544 cells/μl, and the frail patients accounted for only 6.5% (9/139) at the count in the normal range. There was no significant difference in general data of admission among groups (all P>0.05), but the differences in serum total protein, prealbumin, albumin, APACHE Ⅱ score, SOFA score, and frailty score were statistically significant (all P<0.01). The difference in survival rate among the three groups was statistically significant (P<0.01). Conclusion Due to interactions of nutritional and immune status in chronic renal failure patients, the frail status cannot be ignored. The immune status of the patient can be improved by monitoring CD4 ⁺ T lymphocyte count and timely improving nutritional status, thereby improving the prognosis.

Key words: kidney failure,chronic, frailty, malnutrition, immunocompromised host, CD4⁺ T lymphocytes count

CLC Number:

R692.5

Li Yingying, Li Ting, Zhang Ming, Fan Minghua, Xing Guangqun. Monitoring significance of CD4⁺ T lymphocyte count on evaluating frailty status of chronic renal failure in patients[J]. Clinical Focus, 2022, 37(3): 243-247.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.03.008

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I3/243

Figures/Tables 8

References 27

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项目	A组(n=67)	B组(n=175)	C组(n=139)	统计值	P值
年龄	60.00(54.09,62.87)	65.00(59.97,64.99)	58.00(55.78,61.19)	H=1.290	0.069
性别[例(%)]
男女	35(52.2) 32(47.8)	86(49.1) 89(50.9)	77(55.4) 62(44.6)	χ²=2.567	0.277
透析方式[例(%)]
血液透析腹膜透析	19(28.4) 11(16.4)	78(44.6) 22(12.6)	43(30.9) 22(15.8)	χ²=12.704	0.122
原发病[例(%)]
慢性肾小球肾炎	22(32.8)	58(33.1)	53(38.1)	χ²=0.125	0.940
糖尿病肾病	21(31.3)	59(33.7)	45(32.4)	χ²=0.163	0.922
高血压肾病	16(23.9)	28(16.0)	23(16.6)	χ²=2.080	0.354
痛风性肾病	2(3.0)	2(1.1)	2(1.4)	χ²=1.052	0.591
梗阻性肾病	1(1.5)	7(4.0)	5(3.6)	χ²=0.967	0.617
多囊肾	0(0)	8(4.6)	2(1.4)	χ²=4.943	0.084
药物所致肾衰竭	1(1.5)	3(1.7)	1(0.7)	χ²=0.537	0.764
其他原因	4(6.0)	10(5.7)	8(5.8)	χ²=0.017	0.991

项目	A组(n=67)	B组(n=175)	C组(n=139)	统计值	P值
年龄	60.00(54.09,62.87)	65.00(59.97,64.99)	58.00(55.78,61.19)	H=1.290	0.069
性别[例(%)]
男女	35(52.2) 32(47.8)	86(49.1) 89(50.9)	77(55.4) 62(44.6)	χ²=2.567	0.277
透析方式[例(%)]
血液透析腹膜透析	19(28.4) 11(16.4)	78(44.6) 22(12.6)	43(30.9) 22(15.8)	χ²=12.704	0.122
原发病[例(%)]
慢性肾小球肾炎	22(32.8)	58(33.1)	53(38.1)	χ²=0.125	0.940
糖尿病肾病	21(31.3)	59(33.7)	45(32.4)	χ²=0.163	0.922
高血压肾病	16(23.9)	28(16.0)	23(16.6)	χ²=2.080	0.354
痛风性肾病	2(3.0)	2(1.1)	2(1.4)	χ²=1.052	0.591
梗阻性肾病	1(1.5)	7(4.0)	5(3.6)	χ²=0.967	0.617
多囊肾	0(0)	8(4.6)	2(1.4)	χ²=4.943	0.084
药物所致肾衰竭	1(1.5)	3(1.7)	1(0.7)	χ²=0.537	0.764
其他原因	4(6.0)	10(5.7)	8(5.8)	χ²=0.017	0.991

组别	ALB (g/L)	PAB (mg/L)	TP (g/L)	T淋巴细胞计数 (×10⁹/L)	SCr (μmol/L)	估算肾小球滤过率 [ml/ (min·1.73 m²)]	TC (mmol/L)	LDL-C (mmol/L)
A组	26.25 (23.78,29.49)	179.00 (134.98,228.12)	53.50 (39.13,91.61)	0.61 (0.24,1.76)	541.60 (415.23,659.40)	6.00 (5.32,10.68)	3.55 (2.83,4.98)	2.84 (2.18,17.57)
B组	31.60 (29.79,32.46)	219.00 (201.86,251.95)	60.40 (59.22,66.35)	0.90 (0.93,0.90)	521.50 (433.25,581.09)	6.00 (7.42,17.03)	4.2 (0.11,17.62)	2.70 (2.44,3.12)
C组	33.91 (34.25,40.94)	211.50 (197.56,246.38)	58.40 (56.66,64.57)	1.36 (1.31,1.65)	573.75 (485.04,645.62)	6.00 (6.25,9.75)	3.81 (3.57,4.89)	2.59 (2.51,3.73)
统计值	H=26.485	H=15.961	H=14.053	H=2.492	H=1.109	H=1.057	H=3.920	H=2.588
P值	<0.01	<0.01	<0.01	0.077	0.582	0.346	0.144	0.080

组别	ALB (g/L)	PAB (mg/L)	TP (g/L)	T淋巴细胞计数 (×10⁹/L)	SCr (μmol/L)	估算肾小球滤过率 [ml/ (min·1.73 m²)]	TC (mmol/L)	LDL-C (mmol/L)
A组	26.25 (23.78,29.49)	179.00 (134.98,228.12)	53.50 (39.13,91.61)	0.61 (0.24,1.76)	541.60 (415.23,659.40)	6.00 (5.32,10.68)	3.55 (2.83,4.98)	2.84 (2.18,17.57)
B组	31.60 (29.79,32.46)	219.00 (201.86,251.95)	60.40 (59.22,66.35)	0.90 (0.93,0.90)	521.50 (433.25,581.09)	6.00 (7.42,17.03)	4.2 (0.11,17.62)	2.70 (2.44,3.12)
C组	33.91 (34.25,40.94)	211.50 (197.56,246.38)	58.40 (56.66,64.57)	1.36 (1.31,1.65)	573.75 (485.04,645.62)	6.00 (6.25,9.75)	3.81 (3.57,4.89)	2.59 (2.51,3.73)
统计值	H=26.485	H=15.961	H=14.053	H=2.492	H=1.109	H=1.057	H=3.920	H=2.588
P值	<0.01	<0.01	<0.01	0.077	0.582	0.346	0.144	0.080

组别	APACHEⅡ评分(分)	SOFA评分(分)	衰弱评分(分)	死亡人数[例(%)]
A组	24.00(23.19,25.88)	18.00(17.51,18.96)	9.00(8.1,9.12)	11(0.16)
B组	16.00(14.56,15.91)^*	13.00(12.31,13.59)^*	5.00(4.78,5.44)^*	12(0.07)^*
C组	7.00(6.79,7.56)^*#	7.00(6.20,6.91)^*#	1.50(1.62,2.15)^*#	8(0.06)^*#
统计值	H=449.401	H=282.378	H=9.392	χ²=9.002
P值	<0.01	<0.01	<0.01	0.010