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Related Experiment Videos

Cellular defense in critically ill surgical patients.

J A Bradley, D N Hamilton, M W Brown

    Critical Care Medicine
    |July 1, 1984
    PubMed
    Summary

    Critically ill surgical patients with intact cell-mediated immunity had lower mortality rates in the ICU. Reactivity to recall antigens indicates a better prognosis, suggesting immune status impacts survival.

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    Area of Science:

    • Immunology
    • Critical Care Medicine
    • Surgical Outcomes

    Background:

    • Cell-mediated immunity plays a crucial role in patient outcomes.
    • Assessing immune function in critically ill patients is vital for prognosis.
    • Surgical patients in the ICU present unique challenges for immune response evaluation.

    Purpose of the Study:

    • To investigate the relationship between cell-mediated immunity and mortality in critically ill surgical patients.
    • To evaluate the predictive value of recall antigen testing for survival in the ICU.
    • To explore potential mechanisms underlying immune dysfunction in this patient population.

    Main Methods:

    • Cell-mediated immunity was assessed using 4 recall antigens in 102 critically ill surgical patients.

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  • Patient reactivity (reactors vs. non-reactors) was correlated with mortality rates.
  • In vitro lymphocyte responses to mitogens (concanavalin A, phytohemagglutinin, pokeweed) and chemotaxis of mononuclear and granulocyte cells were analyzed.

    • Main Results:

    • Mortality was significantly lower in patients with positive recall antigen reactions (14%) compared to non-reactors (45%) (p < .01).
    • Among non-reactors remaining in the ICU >7 days, conversion to reactivity correlated with a significant decrease in mortality (70% vs. 20%, p < .001).
    • Lymphocyte response to concanavalin A was reduced, while responses to phytohemagglutinin and pokeweed mitogen were normal; chemotaxis showed a slight increase.

    Conclusions:

    • Intact cell-mediated immunity, as indicated by recall antigen reactivity, is associated with improved survival in critically ill surgical patients.
    • Impaired T-cell function may contribute to the reduced immune response observed in non-reactors.
    • Immune status assessment could offer prognostic insights for surgical patients in intensive care.