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Substrate composition and sepsis. Effects on immunity.

T J Mullin, J R Kirkpatrick

    Archives of Surgery (Chicago, Ill. : 1960)
    |February 1, 1983
    PubMed
    Summary
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    Nutritional support in malnourished patients with sepsis did not alter immune response based on substrate composition. Positive nitrogen balance improved immune markers like absolute lymphocyte count, irrespective of the formula used.

    Area of Science:

    • Clinical Nutrition
    • Immunology
    • Critical Care Medicine

    Background:

    • Malnutrition and sepsis significantly impair immune function.
    • Nutritional substrate composition is hypothesized to influence immune recovery in critical illness.

    Purpose of the Study:

    • To investigate the impact of different nutritional substrate compositions on immune response in septic malnourished patients.
    • To determine if substrate composition affects immunologic responsiveness in sepsis.

    Main Methods:

    • A randomized prospective study comparing two nutritional regimens in septic and nonseptic malnourished patients.
    • Regimen 1: Balanced substrate formula (40 kcal/kg/day, 1-1.5g protein/kg/day, CHO:N ratio 50:1).
    • Regimen 2: Dextrose and protein solution (50 kcal/kg/day, 1-1.5g protein/kg/day, CHO:N ratio 150:1).

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    Main Results:

    • Skin test conversion rates were unaffected by substrate composition.
    • Absolute lymphocyte count significantly improved in septic patients achieving positive nitrogen balance.
    • Improvement in immune markers was independent of the specific nutritional support regimen.

    Conclusions:

    • Nutritional substrate composition does not appear to directly affect immunologic responsiveness in septic malnourished patients.
    • Achieving a positive nitrogen balance is crucial for improving immune function in this patient population.
    • Focusing on achieving positive nitrogen balance may be more critical than substrate composition for immune recovery.