The Primary Deficiency Resulting From Acute Severe Illness in Nonimmunocompromised Patients Is Not the CD4+ Subtype, but the Total Number of Lymphocytes

In their interesting article, Aldrich et al¹ reported the CD4⁺ lymphocyte counts of 53 patients admitted to an intensive care unit for diverse infectious and noninfectious conditions and who tested negative for human immunodeficiency virus. The authors found a high rate of absolute CD4⁺ lymphopenia among these patients, whereas the percentage of these cells and the CD4/CD8 ratio was normal in most of them. As noted by the authors, the fact that the relative counts of CD4⁺ lymphocytes were normal in most of these patients and the absolute counts were low suggests that the key point is not CD4⁺ lymphopenia but panlymphopenia. However, the authors did not analyze or report the total lymphocyte counts.