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The delayed hypersensitivity response: application in clinical surgery

J B Pietsch, J L Meakins, L D MacLean

    Surgery
    |September 1, 1977
    PubMed
    Summary
    This summary is machine-generated.

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    Delayed hypersensitivity skin testing in surgical patients revealed that impaired immune responses significantly correlate with higher sepsis and mortality rates. Early detection and intervention, including nutritional support, can improve patient outcomes.

    Area of Science:

    • Immunology
    • Surgical Oncology
    • Critical Care Medicine

    Background:

    • Delayed hypersensitivity skin testing (DHST) assesses cellular immune function.
    • Immune dysfunction is linked to adverse outcomes in surgical patients.
    • Prevalence and prognostic significance of anergy in surgical settings require further elucidation.

    Purpose of the Study:

    • To evaluate the incidence and prognostic value of abnormal delayed hypersensitivity skin test responses in diverse surgical patient cohorts.
    • To identify factors associated with anergy and relative anergy.
    • To explore the impact of therapeutic interventions on immune status and patient outcomes.

    Main Methods:

    • Delayed hypersensitivity skin testing was conducted on 520 surgical patients across preoperative, postoperative/post-trauma, and nonoperative groups.

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  • Sequential testing was performed in individual patients to assess changes in immune response over time.
  • Statistical analysis was used to compare sepsis and mortality rates between normal and abnormal responders.

    • Main Results:

    • Patients with abnormal DHST responses exhibited significantly higher incidences of sepsis (57.6%) and mortality (78%) compared to normal responders (sepsis 10.1%, mortality 8.4%).
    • Sequential testing demonstrated that improving or maintaining normal immune responses correlated with better outcomes.
    • Anergy and relative anergy were associated with malnutrition, sepsis, shock, and trauma, independent of cancer or advanced age, although cancer increased mortality.

    Conclusions:

    • Abnormal delayed hypersensitivity skin test responses are a significant predictor of sepsis and mortality in surgical patients.
    • Reversal of anergy through management of associated conditions, particularly nutritional support via total parenteral nutrition, can improve prognosis.
    • DHST is a valuable prognostic tool in surgical patient management, guiding therapeutic strategies.