Beneficial effect of enhanced macrophage function in the trauma patient.
Host immunosuppression after trauma contributes to septic morbidity. The macrophage is a key element in the host immune response. This study evaluated glucan, a macrophage stimulant, in a prospective, randomized, double-blind study of 38 trauma patients undergoing surgery. Glucan (21 patients), 50 mg/m2, or placebo (17 patients) was given intravenously daily for 7 days. Delayed hypersensitivity skin testing was performed on days 1 and 7 after trauma. Serum interleukin-1 (IL-1) and tumor necrosis factor (TNF) were assayed after trauma. While the total mortality rate was significantly less in the glucan group (0% versus 29%) (p less than 0.05), the mortality rate from sepsis was not statistically different (0% versus 17.6%). Glucan therapy significantly decreased septic morbidity (9.5% versus 49%; p less than 0.05). Serum IL-1 had a greater increase in glucan patients on day 3 after trauma (143.4 +/- 19.3% versus 78.6 +/- 11.7%; p less than 0.05), but there was no difference thereafter. Serum TNF did not vary between groups. Early increase in IL-1 correlated with subsequent skin test conversion to positive. Neither serum IL-1 nor TNF was a reliable indicator of future sepsis. Further clinical trials are indicated to evaluate biologic response modifiers that activate macrophages in the trauma patient.
Browder
W
W
Tulane University, Department of Surgery, New Orleans, LA 70112.
Williams
D
D
Pretus
H
H
Olivero
G
G
Enrichens
F
F
Mao
P
P
Franchello
A
A
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005936:Glucans / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017053:Infection Control; D007375:Interleukin-1 / Q000032:analysis; D008262:Macrophage Activation / Q000187:drug effects*; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012882:Skin Tests; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014946:Wound Infection / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications / Q000276:immunology*
D005936:Glucans; D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha