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Further Evidence of an Organism-Independent, Host-Dependent Response

Clifford Scott Deutschman, MD; Frank N. Konstantinides; Michael Tsai, PhD; Richard L. Simmons, MD; Frank B. Cerra, MD

Arch Surg. 1987;122(1):21-25.

Abstract
• The hypothesis has been advanced that the human systemic septic response is a function of the host and not of the type of infecting organism. Metabolic and physiologic data from five immunosuppressed transplant recipients with isolated cytomegaloviral sepsis and viremia were prospectively evaluated. Serial cultures obtained from lung, sputum, urine, wound, blood, and invasive lines were positive for virus and negative for bacterial or fungal pathogens. The results were compared with two data banks derived from either victims of multiple trauma without sepsis or surgical patients with early bacterial or fungal sepsis. Statistically significant differences between the patients and the nonseptic reference group were noted for cardiac index, total peripheral resistance, arteriovenous oxygen content difference, oxygen consumption, and levels of triglycerides, proline, phenylalanine, tyrosine, -aminobutyrate, and alanine. No such differences were present for these data compared with the septic reference group. Physiologic data obtained just before death in three patients indicated a failure of oxygen transport. It appears that the systemic septic response to viral agents is indistinguishable by physiologic and metabolic criteria from that resulting from bacterial or fungal agents.

(Arch Surg 1987;122:21-25)

Author Affiliations
From the Departments of Surgery (Drs Deutschman, Simmons, and Cerra) and Pathology (Dr Tsai), University of Minnesota Hospitals, Minneapolis; and the Surgical-Metabolic Research Facility, St Paul—Ramsey Medical Center, St Paul (Drs Deutschman and Cerra and Mr Konstantinides). Dr Deutschman is now with the Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore.

Footnotes
Accepted for publication July 9, 1986.

Read before the Sixth Annual Meeting of the Surgical Infection Society, Chicago, April 21, 1986.

Reprint requests to Department of Anesthesiology and Critical Care Medicine, Blalock 14, The Johns Hopkins University School of Medicine, Baltimore, MD 21205 (Dr Deutschman).

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