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Anergic Patients Before Elective Surgery Have Enhanced Nonspecific Host-Defense Capacity
Jose M. Tellado, MD;
Betty Giannias;
Bomi Kapadia;
Louise Chartrand, RN;
Mary de Santis, RN;
Nicolas V. Christou, MD, PhD
Arch Surg. 1990;125(1):49-53.
Abstract
• Albeit anergy in patients before surgery is associated with an increase in septic-related complications and mortality, it is not clear whether this is due to a downregulated nonspecific host defense or a specific cellular immune defect. We studied polymorphonuclear leukocyte neutrophil (PMN) function in 14 patients who were admitted for elective surgery and compared them with 5 healthy controls. At admission, patients were classified according to their delayed-type hypersensitivity skin test response into reactive or anergic groups. In vivo PMN delivery to skin windows, the plasma lactoferrin level, serum and skin window fluid chemoattractant activity, and in vitro superoxide production were measured. Compared with reactive patients, anergic patients showed an increased cell delivery (8.7x 106 PMNs per well vs 1.6x 106 PMNs per well), an increased plasma lactoferrin level (4.4± 1.5 mg/L vs 3.1 ± 0.8 mg/L), an increased chemoattractant capacity of serum and skin window fluid (38 ± 21 cells per high-power field vs 16.8±7.2 cells per high-power field), and an increased superoxide production. We concluded that nonspecific host defense, as reflected by PMNs, is enhanced in anergic patients before surgery and may not explain the increased susceptibility to infection.
(Arch Surg. 1990;125:49-53)
Author Affiliations
From the Departments of Surgery (Drs Tellado and Christou, Mss Giannias, Chartrand, and de Santis, and Mr Kapadia) and Microbiology and Immunology (Dr Christou), McGill University, Montreal, Canada.
Footnotes
Accepted for publication September 26, 1989.
Read before the Ninth Annual Meeting of the Surgical Infection Society, Denver, Colo, April 13, 1989.
Reprint requests to c/o N. V. Christou, MD, PhD, Royal Victoria Hospital, 687 Pine Ave W, Room S10.30, Montreal, Quebec, Canada H3A 1A1 (Dr Tellado).
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