[Study of delayed skin hypersensitivity using the multitest in an intensive care unit]

Area of Science:

• Immunology
• Critical Care Medicine
• Prognostic Biomarkers

Background:

• Assessing immune status is crucial for predicting outcomes in Intensive Care Unit (ICU) patients.
• Delayed-type hypersensitivity (DTH) skin testing is a method to evaluate cell-mediated immunity.
• Previous methods for DTH testing were less efficient for critically ill patients.

Purpose of the Study:

• To evaluate the utility of a novel multiple puncture skin test for assessing DTH in ICU patients.
• To determine the prognostic value of DTH reactivity on patient infection and mortality.
• To investigate the changes in immune response over time during ICU hospitalization.

Main Methods:

• A cohort of 76 ICU patients underwent a multiple puncture skin test using 7 common antigens.
• Skin reactivity was assessed on admission (Day 0), Day 7, and Day 14.
• Analysis correlated DTH responses with subsequent infection rates and mortality.

Main Results:

• A significant association was found between anergy (lack of skin reactivity) and increased mortality (p < 0.001).
• Anergic patients exhibited an 85.71% mortality rate, with 90% of deaths attributed to infection.
• Immune responses showed dynamic changes throughout hospitalization, indicating the need for repeated testing.

Conclusions:

• Cell-mediated immunity assessment via skin testing in ICU patients can serve as a valuable prognostic tool.
• Repeated DTH testing during hospitalization is essential, as immune status can change significantly up to Day 14.
• A single DTH test on admission is insufficient for accurate long-term prognosis in ICU patients.