Neutrophil Function in Anergic Surgical Patients

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Abstract
Skin test anergy (A) to recall antigens identifies surgical patients at high risk for sepsis. Neutrophil function was studied in such patients to assess any alteration in their host defense mechanisms. Neutrophil adherence was measured with a modified adherence assay capable of measuring the adherence of neutrophils in whole blood or purified neutrophil suspensions and neutrophil chemotaxis was assessed by the Boyden technique. Of the laboratory controls, 21 had a neutrophil adherence of 71.5 .+-. 3.8% (mean .+-. SD) and chemotaxis of 128.1 .+-. 2.4 .mu. (mean .+-. SD). Of the hospitalized patients with normal skin tests, 54 had neutrophil adherence of 72.5 .+-. 13.1% (P .apprx. 0.5 relative to control) and chemotaxis of 123.3 .+-. 3.1 .mu. (P .apprx. 0.5). Of relatively anergic patients, 23 had values of 84.3 .+-. 7.9% (P < 0.001) and 103.7 .+-. 2.0 .mu. (P < 0.001). Of A patients, 45 had adherence of 85.0 .+-. 7.0% (P < 0.001) and chemotaxis of 90.4 .+-. 2.9 .mu. (P < 0.001). The correlation coefficient between increased neutrophil adherence and decreased chemotaxis (r = 0.81) has P < 0.0005. A factor which increased the adherence of normal control neutrophils was found in the plasma but not the serum of anergic patients. Inhibitors of control neutrophil chemotaxis were shown in serum and plasma of patients with decreased autologous neutrophil chemotaxis. This altered neutrophil function (possibly with other defects) in anergic patients may compromise their host defenses and render them susceptible to infection.

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