Circulating and exudative polymorphonuclear neutrophil priming and oxidative capacity in anergic surgical patients.
OBJECTIVE
To examine the oxidative capacity of circulating and exudate polymorphonuclear neutrophils from reactive patients and anergic patients before surgery to determine why anergic patients have increased sepsis-related mortality once an infectious complication develops.


METHODS
Prospective in vitro patient study.


METHODS
Tertiary care, major university teaching hospital.


METHODS
Surgical patients admitted for major elective gastrointestinal surgery.


METHODS
We used flow cytometry and the dye 2-7-dichlorofluorescein diacetate to measure hydrogen peroxide production of circulating and exudate polymorphonuclear neutrophils at baseline and after stimulation with Staphylococcus epidermidis.


RESULTS
We found that polymorphonuclear neutrophils were primed in the intravascular space as evidenced by increased numbers of formyl-methionyl-leucyl-phenylalanine receptors, increased hydrogen peroxide production at baseline, and increased hydrogen peroxide production with stimulation. These results were more evident in the anergic patient. After exudation, anergic polymorphonuclear neutrophils lost most of their capacity to produce additional hydrogen peroxide.


CONCLUSIONS
The data suggest that this intravascular priming adversely affected polymorphonuclear neutrophils during exudation, more marked in the anergic patient, and may contribute to the sepsis-related mortality of the anergic patients.
Department of Surgery, McGill University, Montreal, Quebec.
J M
JM
Tellado
N V
NV
Christou
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D005434:Flow Cytometry; D006801:Humans; D006861:Hydrogen Peroxide / Q000378:metabolism; D006968:Hypersensitivity, Delayed / Q000378:metabolism*; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010084:Oxidation-Reduction; D011446:Prospective Studies; D017459:Receptors, Amino Acid / Q000032:analysis; D016897:Respiratory Burst; D013212:Staphylococcus epidermidis / Q000502:physiology; D013514:Surgical Procedures, Operative; D000515:alpha 1-Antitrypsin / Q000032:analysis
D017459:Receptors, Amino Acid; D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein; D006861:Hydrogen Peroxide