Cellular defense in critically ill surgical patients.
Cell-mediated immunity was examined using 4 recall antigens in 102 critically ill surgical patients treated in an ICU. There were 4 (14%) deaths in 28 patients with positive reactions (R), compared to 33 (45%) deaths in 74 nonreactors (NR) (p less than .01). Thirty-seven of the patients were admitted after trauma, and mortality in this group was not significantly different between R and NR patients. Repeat testing in 40 NR patients who remained in the ICU for more than 7 days showed that 30 remained NR (70% mortality) and 10 became R (20% mortality, p less than .001). Peripheral blood lymphocytes from the patients showed a reduced response to concanavalin A, but a normal response to phytohemagglutinin and pokeweed mitogen. Mononuclear cells and granulocytes both showed a small increase in chemotactic response to casein, suggesting that the reduced response to skin testing may be partly due to defective T-cell function, rather than impaired phagocyte chemotaxis.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002634:Chemotaxis, Leukocyte; D003208:Concanavalin A / Q000276:immunology; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007239:Infections / Q000276:immunology*; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D009504:Neutrophils / Q000276:immunology; D010835:Phytohemagglutinins / Q000276:immunology; D011043:Pokeweed Mitogens / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology*; D012882:Skin Tests
D010835:Phytohemagglutinins; D011043:Pokeweed Mitogens; D003208:Concanavalin A