Circulating and exudative polymorphonuclear neutrophil priming and oxidative capacity in anergic surgical patients
J. M. Tellado and N. V. Christou
Department of Surgery, McGill University, Montreal, Quebec.
OBJECTIVES: 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. DESIGN:
Prospective in vitro patient study. SETTING: Tertiary care, major
university teaching hospital. PARTICIPANTS: Surgical patients admitted for
major elective gastrointestinal surgery. MAIN OUTCOME AND MEASURES: 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.
