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Preoperative Risk Factors Influencing the Incidence of Postoperative Sepsis in Human Immunodeficiency Virus-Infected Patients: A Retrospective Cohort Study

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Abstract

Background

Compared to noninfected patients, human immunodeficiency virus (HIV)-infected patients undergoing surgery have an increased postoperative risk of developing sepsis. We aimed to investigate the preoperative risk factors that affect the incidence of sepsis after surgery in HIV-infected patients.

Methods

Clinical parameters of 215 patients with HIV/acquired immunodeficiency syndrome (AIDS) who had undergone surgery between January 2011 and February 2012 were examined retrospectively for the effect of HIV/AIDS on the incidence of postoperative sepsis.

Results

Logistic regression analysis identified four independent risk factors of postoperative sepsis in HIV-infected patients: CD4 counts [B = −0.007, odds ratio (OR) 0.993]; blood albumin levels (B = −0.077, OR 0.926); surgical infection (B = 1.887, OR 6.598); major surgery (B = 1.013, OR 2.754). The incidence of postoperative sepsis was high with CD4 counts ≤ 100 cells/μl, albumin levels <35 g/L, the presence of surgical infection, the patient had undergone major surgery—81.25%, 39/48; 76.47%, 26/34; 70.73%, 29/41; and 54.76%, 46/84, respectively, compared to that of the total cohort (40.93%, 88/215). When CD4 counts were >350 cells/μl, the incidence of postoperative sepsis was significantly lower (16.36%, 9/55).

Conclusions

Low CD4 cell counts, hypoalbuminemia, surgical infection, and major surgery are independent risk factors for the development of postoperative sepsis among HIV-infected patients. CD4 cell numbers and albumin levels negatively correlated with the incidence of postoperative sepsis, whereas surgical infections and major surgical procedures positively correlated with the incidence of postoperative sepsis.

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Acknowledgments

The authors thank all the colleagues of the Department of Surgery at Shanghai Public Health Clinical Center Affiliated with Fudan University for their assistance with data collection. A.T. and B.L. are supported by the National Science Foundation of China (NSFC) 31170825, 81271835, 31200646, NSFC-NIH 81161120417; the Shanghai “Rising Star” program 10QA1407900; and the Novo Nordisk–Chinese Academy of Sciences Foundation. B.L. is a recipient of the CAS “100-Talent” program award. A.T. is a recipient of a CAS “International Young Scientist Fellowship” award and is supported by NSFC 31150110337. A.T. and B.L. gratefully acknowledge the support of the Sanofi-Aventis-Shanghai Institutes for Biological Sciences scholarship program and the Knowledge Innovation Program of Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences 2012KIP204.

Conflict of interest

No author has any commercial associations that would create a conflict of interest in connection with this study.

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Authors and Affiliations

  1. Department of Surgery, Shanghai Public Health Clinical Center Affiliated with Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China

    Jinsong Su, Lei Zhang, Xianjun Xia & Baochi Liu

  2. Department of Stomatology, Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, China

    Ruizhang Guo

  3. Unit of Molecular Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China

    Andy Tsun & Bin Li

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  1. Jinsong Su
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  2. Andy Tsun
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  3. Lei Zhang
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  7. Baochi Liu
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Correspondence to Baochi Liu.

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Su, J., Tsun, A., Zhang, L. et al. Preoperative Risk Factors Influencing the Incidence of Postoperative Sepsis in Human Immunodeficiency Virus-Infected Patients: A Retrospective Cohort Study. World J Surg 37, 774–779 (2013). https://doi.org/10.1007/s00268-013-1915-y

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