Host-defence mechanisms in surgical patients: a correlative study of the delayed hypersensitivity skin-test response, granulocyte function and sepsis.

To identify associations between abnormal measurements and development of life-threatening surgical sepsis, host-defence parameters were assessed in 2202 patients upon admission to hospital for operation. Measurements included the response to delayed type hypersensitivity (DTH) skin-test antigens, circulating blood-cell counts and hemoglobin levels, neutrophil adherence, chemotaxis, phagocytic and bactericidal function, and circulating serum albumin, serum globulin, serum immunoglobulin and complement levels. Sepsis was considered to be present when there was bacteremia, proven cholangitis or intracavitary abscess proven by operation or autopsy. The admission DTH response stratified patients into a reactive group (responding to two or more antigens out of five, 1373 patients), a relatively anergic group (with a response to one antigen, 306 patients) and an anergic group (with no antigen response, 523 patients). Sex, age and type of disease were similar in the three groups. There were abnormalities in neutrophil adherence, neutrophil chemotaxis, serum albumin and blood hemoglobin levels in all groups, compared with out-of-hospital controls. The reactive group had an 8% sepsis rate and a mortality of 4%, compared with 21% and 15% in the relatively anergic and 33% and 31% in the anergic groups respectively (chi 2 = 186, p less than 0.0001). The same observation was made in 1184 patients who were studied preoperatively: sepsis rates were 8%, 16% and 31% in the reactive, relatively anergic and anergic groups respectively (chi 2 = 76, p less than 0.0001) and mortality was 4%, 12% and 27% respectively (chi 2 = 99.7, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)