“Survival following penetrating abdominal trauma has improved significantly, nonetheless despite enhanced resuscitation and surgical intervention strategies the immune mediated systemic inflammatory response syndrome (SIRS) continues to result in organ dysfunction and potential death. Posttraumatic lymphopenia or altered cell-mediated immunity as a result of decreased lymphocyte subsets may affect SIRS severity; however in penetrating trauma it is uncertain which factors may result in decreased CD4 counts and whether or not these changes affect postoperative outcomes, in particular anastomotic complications.”

“This prospective study demonstrated that a low post-operative CD4 count may be a predictor of anastomotic leaks independent of previously reported factors. The postoperative CD4 count together with the postoperative albumin level taken 24 h after initial surgery, as well as severity of intra-abdominal injuries should be considered in the decision-making process of performing an anastomosis or diverting stoma in patients after “clip and drop” of
the bowel as part of damage control surgery”

Mauser, Martin et al. “Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma.” Injury vol. 50,1 (2019): 167-172. doi:10.1016/j.injury.2018.11.028