[Hyperalimentation after digestive surgery: influence on immune state and on prognosis (author's transl)]

Immunocompetence was measured in 320 gastrointestinal surgery patients using the delayed hypersensitivity test. The frequency of complications and death from sepsis was greater (p less than 0,001) in anergic patients (39%) than in patients with normal response (5%). A close correlation was observed between anergy and malnutrition as determined on the basis of biological criteria (triceps skinfold, arm circumference, ratio between actual and deal weights). This double correlation led to study the influence of hyperalimentation on immune response and prognosis. Parenteral hyperalimentation with nitrogen and calories was administered to 26 anergic patients with heavy or complicated intestinal surgery (peritonitis) for from 10 to 37 days (av.: 19, 2 days). One or more test(s) had turned positive by the 10th day in 7 patients; by the 30th day in 16 and by the 69th day in 20. Out of 26 anergic patients, 19 were nutritionally normal; hyperalimentation had no influence on biological criteria and began to modify body measurements only after 17 days; in the 16 anergic malnourished patients,, hypernutrition led to the development of a positive nitrogen balance (3,60 +/- 1,7 days) and to a return within normal range of biological criteria (7,2 +/- 2,3 days), and body measurements (14,3 +/- 9,2 days). Death from sepsis in anergic patients with hyperalimentation was lower (11,2% and 44,4%; p less than 0,01) than in anergic ones without hyperalimentation. Hyperalimentation with nitrogen and calories modified the nutritional status, immunological response and improved prognosis in anergic patients.