A controlled study of leukocyte activation in septic patients.
OBJECTIVE
Qualitative and quantitative evaluation of leukocyte activation in septic patients in comparison to two control groups.


METHODS
A prospective clinical study in which the leukocyte oxidative output of whole blood was measured in three groups of patients. Two chemiluminescence markers (luminol or lucigenin), indicative of either total oxidant output or superoxide production, and three stimuli (opsonized zymosan, formyl-methionyl-leucyl-phenylalanine (fMLP), phorbol myristate acetate) (PMA), representing different pathways of leukocyte activation, were used. Tumor necrosis factor, interleukin-6 and C-reactive protein (TNF, IL-6, and CRP) were determined to evaluate the severity of the inflammatory process.


METHODS
Intensive care and surgical units of a university hospital.


METHODS
Seventy-four healthy patients, ten ICU patients without signs of sepsis or systemic inflammatory response syndrome and 19 septic patients were studied.


RESULTS
With all three stimuli, whole blood total oxidative output and superoxide production were generally increased in septic patients. This was most likely due to the increased leukocyte numbers in these patients. When the chemiluminescence values were normalized per phagocyte (granulocytes and monocytes), the total oxidative output of septic phagocytes decreased with opsonin and fMLP but increased with PMA, while superoxide output decreased regardless of the stimuli used. TNF, IL-6 and CRP, although increased in septic patients as compared to ICU controls, correlated weakly with oxidant output.


CONCLUSIONS
The oxidative output of whole blood was increased in septic patients compared to controls because of elevated leukocyte numbers. However, oxidant output normalized for phagocyte numbers generally decreases during sepsis for most stimuli. Cytokines and CRP do not appear to be associated with the extent of oxidant output during sepsis.
Pascual
C
C
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University, Jena, Germany.
Karzai
W
W
Meier-Hellmann
A
A
Bredle
D L
DL
Reinhart
K
K
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation; D011446:Prospective Studies; D016897:Respiratory Burst; D018805:Sepsis / Q000276:immunology* / Q000378:metabolism*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein