Anergy in patients with biliary lithiasis

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Abstract
A prospective study was carried out in 428 subjects (212 controls and 216 patients) to evaluate the delayed cell-mediated immune response preoperatively in patients with biliary lithiasis. The delayed hyper-sensitivity response was assessed by a Multitest and subjects were classified as immunocompetent, relatively anergic or anergic. Significant differences were found between control subjects and patients with cholelithiasis compared with those with acute cholecystitis (P < 0·01), non-icteric choledocholithiasis (P < 0·01) and choledocholithiasis with jaundice (P < 0·05). There were also differences between patients with icteric and non-icteric choledocholithiasis (P < 0·02). Seven possible causative factors for anergy were evaluated: a haemoglobin concentration of ⩽ 12 g/l and a haematocrit of ⩽ 35 per cent were related to the appearance of anergy and relative anergy in patients with acute cholecystitis. Bilirubin levels ⩾ 34 μmol/l were found in 60 per cent of patients with choledocholithiasis and relative anergy and in 80 per cent of those who were anergic (P < 0·001). These results show a high incidence of failure of the cell-mediated immune response in patients with acute cholecystitis (71 per cent) and icteric choledocholithiasis (82 per cent). In the latter, jaundice appears to be associated with this failure. A close correlation between relatively anergic and anergic state and the development of postoperative septic complications was found.