Depressed Interferon Gamma Production and Monocyte HLA-DR Expression After Severe Injury

doi:10.1001/archsurg.1988.01400350023002

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Vol. 123 No. 11, November 1988

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PAPERS READ BEFORE THE EIGHTH ANNUAL MEETING OF THE SURGICAL INFECTION SOCIETY, SAN FRANCISCO, MAY 5 TO MAY 6, 1988

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Depressed Interferon Gamma Production and Monocyte HLA-DR Expression After Severe Injury

David H. Livingston, MD; Sarah H. Appel; Samuel R. Wellhausen, PhD; Gerald Sonnenfeld, PhD; Hiram C. Polk, Jr, MD

Arch Surg. 1988;123(11):1309-1312.

Abstract

• Monocyte HLA-DR antigen expression and mitogen-stimulatedinterferon gamma production were measured sequentially on days1, 3, 7,14, and 21 after admission in 20 multiply injured patients(mean Injury Severity Score, 33). Ten patients recovered uneventfullyand ten developed a major infection, three of whom died. Traumaresulted in immediate and profound depression of both interferongamma production and monocyte HLA-DR antigen expression comparedwith controls. Interferon gamma remained below control levelsfor all days on which it was measured in all patients. In uninfectedpatients, interferon gamma production began to recover afterday 7 and interferon gamma levels on day 21 were greater thanon all other days. Monocyte HLA-DR antigen expression returnedto normal between days 7 and 14 in uninfected patients, despitesubnormal production of interferon gamma. Failure to increaseinterferon gamma production and monocyte HLA-DR antigen expressionwas associated with an episode of major infection. We postulatethat stimulation of the immune system early after injury mayreverse the defects reported and decrease the incidence of infectionafter severe trauma.

(Arch Surg 1988;123:1309-1312)

Author Affiliations

From the Department of Surgery, Price Institute of Surgical Research (Dr Livingston and Ms Appel); the Department of Internal Medicine, Division of Nephrology (Dr Wellhausen); and the Departments of Microbiology and Immunology and Oral Biology (Dr Sonnenfeld), Schools of Medicine and Dentistry, University of Louisville.

Footnotes

Accepted for publication June 20, 1988.

Read before the Eighth Annual Meeting of the Surgical InfectionSociety, San Francisco, May 6, 1988.

Reprint requests to the Department of Surgery, University ofLouisville, Louisville, KY 40292 (Dr Polk).

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