Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1986 Sep;204(3):282–299.

A systematic study of host defense processes in badly injured patients.

H C Polk Jr, C D George, S R Wellhausen, K Cost, P R Davidson, M P Regan, A P Borzotta
PMCID: PMC1251278  PMID: 3019260

Abstract

A prospective study of factors predisposing to infection in badly injured patients has disclosed: the dominant roles of two specific parameters: monocyte antigen presenting capacity, and opsonic capacity of diluted serum; the potential value of further assessment of: the predictive value of plots of activated T-cells/total T-cells versus monocyte antigen presenting capacity, the apparent protective effect of the ability to sharply increase specific IgM in response to infection, and the apparent protective effect of cytomegalovirus (CMV) infection in the first 28 days after injury against major bacterial infection; the lack of value of analysis of other T- and B-cell subsets in such patients; and the need to clarify CMV and transfusion status with respect to interpretation of such data. The specific role of variable transfusion and of specific serum immunoglobulins will require further and more discriminating study.

Full text

PDF
282

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. W., McClellan M. A., Ogle C. K., Ogle J. D. Consumptive opsoninopathy: possible pathogenesis in lethal and opportunistic infections. Ann Surg. 1976 Dec;184(6):672–678. doi: 10.1097/00000658-197612000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alexander J. W., Ogle C. K., Stinnett J. D., Macmillan B. G. A sequential, prospective analysis of immunologic abnormalities and infection following severe thermal injury. Ann Surg. 1978 Dec;188(6):809–816. doi: 10.1097/00000658-197812000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Baker C. C., Oppenheimer L., Stephens B., Lewis F. R., Trunkey D. D. Epidemiology of trauma deaths. Am J Surg. 1980 Jul;140(1):144–150. doi: 10.1016/0002-9610(80)90431-6. [DOI] [PubMed] [Google Scholar]
  4. Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
  5. Bass D. A., Olbrantz P., Szejda P., Seeds M. C., McCall C. E. Subpopulations of neutrophils with increased oxidative product formation in blood of patients with infection. J Immunol. 1986 Feb 1;136(3):860–866. [PubMed] [Google Scholar]
  6. Bass D. A., Parce J. W., Dechatelet L. R., Szejda P., Seeds M. C., Thomas M. Flow cytometric studies of oxidative product formation by neutrophils: a graded response to membrane stimulation. J Immunol. 1983 Apr;130(4):1910–1917. [PubMed] [Google Scholar]
  7. Beverland D. E., Rutherford W. H. An assessment of the validity of the injury severity score when applied to gunshot wounds. Injury. 1983 Jul;15(1):19–22. doi: 10.1016/0020-1383(83)90156-0. [DOI] [PubMed] [Google Scholar]
  8. Bjornson A. B., Altemeier W. A., Bjornson H. S. Complement, opsonins, and the immune response to bacterial infection in burned patients. Ann Surg. 1980 Mar;191(3):323–329. doi: 10.1097/00000658-198003000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Brown R., Bancewicz J., Hamid J., Patel N. J., Ward C. A., Farrand R. J., Pumphrey R. S., Irving M. Failure of delayed hypersensitivity skin testing to predict postoperative sepsis and mortality. Br Med J (Clin Res Ed) 1982 Mar 20;284(6319):851–853. doi: 10.1136/bmj.284.6319.851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Bull J. P. Measures of severity of injury. Injury. 1978 Feb;9(3):184–187. doi: 10.1016/0020-1383(78)90004-9. [DOI] [PubMed] [Google Scholar]
  11. Burrows L., Tartter P. Effect of blood transfusions on colonic malignancy recurrent rate. Lancet. 1982 Sep 18;2(8299):662–662. doi: 10.1016/s0140-6736(82)92764-7. [DOI] [PubMed] [Google Scholar]
  12. Carney W. P., Rubin R. H., Hoffman R. A., Hansen W. P., Healey K., Hirsch M. S. Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J Immunol. 1981 Jun;126(6):2114–2116. [PubMed] [Google Scholar]
  13. Christou N. V., Meakins J. L. Neutrophil function in surgical patients: two inhibitors of granulocyte chemotaxis associated with sepsis. J Surg Res. 1979 Apr;26(4):355–364. doi: 10.1016/0022-4804(79)90020-9. [DOI] [PubMed] [Google Scholar]
  14. Cohen I. R., Sciutto M. S., Brown G. L., Polk H. C., Jr Failure of opsonization as a sign of lethal sepsis. J Infect Dis. 1984 Apr;149(4):651–651. doi: 10.1093/infdis/149.4.651. [DOI] [PubMed] [Google Scholar]
  15. Cost K. M., West C. S., Brinson D., Polk H. C., Jr Measurement of human antibody activity against Escherichia coli and Pseudomonas aeruginosa using formalin treated whole organisms in an ELISA technique. J Immunoassay. 1985;6(1-2):23–43. doi: 10.1080/01971528508063019. [DOI] [PubMed] [Google Scholar]
  16. De Paoli P., Villalta D., Battistin S., Gasparollo A., Santini G. Selective loss of OKT8 lymphocytes on density gradient centrifugation separation of blood mononuclear cells. J Immunol Methods. 1983 Jul 15;61(2):259–260. doi: 10.1016/0022-1759(83)90170-9. [DOI] [PubMed] [Google Scholar]
  17. Forman S. J., Zaia J. A., Wright C., Gallagher M. T., Blume K. G. Increased Leu-7-positive T lymphocytes during cytomegalovirus infection following allogeneic bone marrow transplantation for hematologic malignancies. Transplantation. 1986 Feb;41(2):268–271. [PubMed] [Google Scholar]
  18. Fosse E., Svennevig J. L., Harboe M. Cell markers in stored blood. Injury. 1985 May;16(6):393–397. doi: 10.1016/0020-1383(85)90054-3. [DOI] [PubMed] [Google Scholar]
  19. Foster R. S., Jr, Costanza M. C., Foster J. C., Wanner M. C., Foster C. B. Adverse relationship between blood transfusions and survival after colectomy for colon cancer. Cancer. 1985 Mar 15;55(6):1195–1201. doi: 10.1002/1097-0142(19850315)55:6<1195::aid-cncr2820550610>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  20. Gallin J. I., Wright D. G., Malech H. L., Davis J. M., Klempner M. S., Kirkpatrick C. H. Disorders of phagocyte chemotaxis. Ann Intern Med. 1980 Apr;92(4):520–538. doi: 10.7326/0003-4819-92-4-520. [DOI] [PubMed] [Google Scholar]
  21. Gascón P., Zoumbos N. C., Young N. S. Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med. 1984 Feb;100(2):173–177. doi: 10.7326/0003-4819-100-2-173. [DOI] [PubMed] [Google Scholar]
  22. Gerrard T. L., Cupps T. R., Jurgensen C. H., Fauci A. S. Hydrocortisone-mediated inhibition of monocyte antigen presentation: dissociation of inhibitory effect and expression of DR antigens. Cell Immunol. 1984 May;85(2):330–339. doi: 10.1016/0008-8749(84)90247-8. [DOI] [PubMed] [Google Scholar]
  23. Goris R. J., Draaisma J. Causes of death after blunt trauma. J Trauma. 1982 Feb;22(2):141–146. doi: 10.1097/00005373-198202000-00011. [DOI] [PubMed] [Google Scholar]
  24. Grzelak I., Olszewski W. L., Engeset A. Influence of operative trauma on circulating blood mononuclear cells: analysis using monoclonal antibodies. Eur Surg Res. 1984;16(2):105–112. doi: 10.1159/000128395. [DOI] [PubMed] [Google Scholar]
  25. Hamid J., Bancewicz J., Brown R., Ward C., Irving M. H., Ford W. L. The significance of changes in blood lymphocyte populations following surgical operations. Clin Exp Immunol. 1984 Apr;56(1):49–57. [PMC free article] [PubMed] [Google Scholar]
  26. Heagy W., Kelley V. E., Strom T. B., Mayer K., Shapiro H. M., Mandel R., Finberg R. Decreased expression of human class II antigens on monocytes from patients with acquired immune deficiency syndrome. Increased expression with interferon-gamma. J Clin Invest. 1984 Dec;74(6):2089–2096. doi: 10.1172/JCI111633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Herberman R. B. Natural killer cells and their possible roles in host resistance against tumors. Transplant Proc. 1984 Apr;16(2):476–478. [PubMed] [Google Scholar]
  28. Howard R. J., Simmons R. L. Acquired immunologic deficiencies after trauma and surgical procedures. Surg Gynecol Obstet. 1974 Nov;139(5):771–782. [PubMed] [Google Scholar]
  29. Kaplan J., Sarnaik S., Gitlin J., Lusher J. Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood. 1984 Jul;64(1):308–310. [PubMed] [Google Scholar]
  30. Keusch G. T., Douglas S. D., Hammer G., Braden K. Antibacterial functions of macrophages in experimental protein-calorie malnutrition. II. Cellular and humoral factors for chemotaxis, phagocytosis, and intracellular bactericidal activity. J Infect Dis. 1978 Aug;138(2):134–142. doi: 10.1093/infdis/138.2.134. [DOI] [PubMed] [Google Scholar]
  31. Ko H. S., Fu S. M., Winchester R. J., Yu D. T., Kunkel H. G. Ia determinants on stimulated human T lymphocytes. Occurrence on mitogen- and antigen-activated T cells. J Exp Med. 1979 Aug 1;150(2):246–255. doi: 10.1084/jem.150.2.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kupper T. S., Green D. R., Durum S. K., Baker C. C. Defective antigen presentation to a cloned T helper cell by macrophages from burned mice can be restored with interleukin-1. Surgery. 1985 Aug;98(2):199–206. [PubMed] [Google Scholar]
  33. Lennard T. W., Shenton B. K., Borzotta A., Donnelly P. K., White M., Gerrie L. M., Proud G., Taylor R. M. The influence of surgical operations on components of the human immune system. Br J Surg. 1985 Oct;72(10):771–776. doi: 10.1002/bjs.1800721002. [DOI] [PubMed] [Google Scholar]
  34. Maderazo E. G., Albano S. D., Woronick C. L., Drezner A. D., Quercia R. Polymorphonuclear leukocyte migration abnormalities and their significance in seriously traumatized patients. Ann Surg. 1983 Dec;198(6):736–742. doi: 10.1097/00000658-198312000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Maher P., O'Toole C. M., Wreghitt T. G., Spiegelhalter D. J., English T. A. Cytomegalovirus infection in cardiac transplant recipients associated with chronic T cell subset ratio inversion with expansion of a Leu-7+ TS-C+ subset. Clin Exp Immunol. 1985 Dec;62(3):515–524. [PMC free article] [PubMed] [Google Scholar]
  36. McLoughlin G. A., Wu A. V., Saporoschetz I., Nimberg R., Mannick J. A. Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma. Ann Surg. 1979 Sep;190(3):297–304. doi: 10.1097/00000658-197909000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Meakins J. L., McLean A. P., Kelly R., Bubenik O., Pietsch J. B., MacLean L. D. Delayed hypersensitivity and neutrophil chemotaxis: effect of trauma. J Trauma. 1978 Apr;18(4):240–247. doi: 10.1097/00005373-197804000-00003. [DOI] [PubMed] [Google Scholar]
  38. Meakins J. L., Pietsch J. B., Bubenick O., Kelly R., Rode H., Gordon J., MacLean L. D. Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma. Ann Surg. 1977 Sep;186(3):241–250. doi: 10.1097/00000658-197709000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Nichols R. L., Smith J. W., Klein D. B., Trunkey D. D., Cooper R. H., Adinolfi M. F., Mills J. Risk of infection after penetrating abdominal trauma. N Engl J Med. 1984 Oct 25;311(17):1065–1070. doi: 10.1056/NEJM198410253111701. [DOI] [PubMed] [Google Scholar]
  40. Nishijima M. K., Takezawa J., Hosotsubo K. K., Takahashi H., Shimada Y., Yoshiya I. Serial changes in cellular immunity of septic patients with multiple organ-system failure. Crit Care Med. 1986 Feb;14(2):87–91. doi: 10.1097/00003246-198602000-00002. [DOI] [PubMed] [Google Scholar]
  41. O'Mahony J. B., Palder S. B., Wood J. J., McIrvine A., Rodrick M. L., Demling R. H., Mannick J. A. Depression of cellular immunity after multiple trauma in the absence of sepsis. J Trauma. 1984 Oct;24(10):869–875. doi: 10.1097/00005373-198410000-00001. [DOI] [PubMed] [Google Scholar]
  42. O'Mahony J. B., Wood J. J., Rodrick M. L., Mannick J. A. Changes in T lymphocyte subsets following injury. Assessment by flow cytometry and relationship to sepsis. Ann Surg. 1985 Nov;202(5):580–586. doi: 10.1097/00000658-198511000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Reinherz E. L., Kung P. C., Pesando J. M., Ritz J., Goldstein G., Schlossman S. F. Ia determinants on human T-cell subsets defined by monoclonal antibody. Activation stimuli required for expression. J Exp Med. 1979 Dec 1;150(6):1472–1482. doi: 10.1084/jem.150.6.1472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Reinherz E. L., Parkman R., Rappeport J., Rosen F. S., Schlossman S. F. Aberrations of suppressor T cells in human graft-versus-host disease. N Engl J Med. 1979 May 10;300(19):1061–1068. doi: 10.1056/NEJM197905103001901. [DOI] [PubMed] [Google Scholar]
  45. Rinaldo C. R., Jr, Ho M., Hamoudi W. H., Gui X. E., DeBiasio R. L. Lymphocyte subsets and natural killer cell responses during cytomegalovirus mononucleosis. Infect Immun. 1983 May;40(2):472–477. doi: 10.1128/iai.40.2.472-477.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Schechter G. P., Soehnlen F., McFarland W. Lymphocyte response to blood transfusion in man. N Engl J Med. 1972 Dec 7;287(23):1169–1173. doi: 10.1056/NEJM197212072872303. [DOI] [PubMed] [Google Scholar]
  47. Schmidt R. E., Hercend T., Schlossman S. F., Ritz J. Functional surface structures on human natural killer cells. Klin Wochenschr. 1985 Dec 2;63(23):1189–1200. doi: 10.1007/BF01733777. [DOI] [PubMed] [Google Scholar]
  48. Snyder D. S., Beller D. I., Unanue E. R. Prostaglandins modulate macrophage Ia expression. Nature. 1982 Sep 9;299(5879):163–165. doi: 10.1038/299163a0. [DOI] [PubMed] [Google Scholar]
  49. Snyder D. S., Unanue E. R. Corticosteroids inhibit murine macrophage Ia expression and interleukin 1 production. J Immunol. 1982 Nov;129(5):1803–1805. [PubMed] [Google Scholar]
  50. Steeg P. S., Johnson H. M., Oppenheim J. J. Regulation of murine macrophage Ia antigen expression by an immune interferon-like lymphokine: inhibitory effect of endotoxin. J Immunol. 1982 Dec;129(6):2402–2406. [PubMed] [Google Scholar]
  51. Tartter P. I., Burrows L., Kirschner P. Perioperative blood transfusion adversely affects prognosis after resection of Stage I (subset N0) non-oat cell lung cancer. J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):659–662. [PubMed] [Google Scholar]
  52. Warden G. D., Mason A. D., Jr, Pruitt B. A., Jr Suppression of leukocyte chemotaxis in vitro by chemotherapeutic agents used in the management of thermal injuries. Ann Surg. 1975 Mar;181(3):363–369. doi: 10.1097/00000658-197503000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Weiss A., Hollander H., Stobo J. Acquired immunodeficiency syndrome: epidemiology, virology, and immunology. Annu Rev Med. 1985;36:545–562. doi: 10.1146/annurev.me.36.020185.002553. [DOI] [PubMed] [Google Scholar]
  54. Williams R. C., Jr, Koster F. T., Kilpatrick K. A. Alterations in lymphocyte cell surface markers during various human infections. Am J Med. 1983 Nov;75(5):807–816. doi: 10.1016/0002-9343(83)90412-6. [DOI] [PubMed] [Google Scholar]
  55. van Es A., Baldwin W. M., Oljans P. J., Tanke H. J., Ploem J. S., van Es L. A. Expression of HLA-DR on T lymphocytes following renal transplantation, and association with graft-rejection episodes and cytomegalovirus infection. Transplantation. 1984 Jan;37(1):65–69. doi: 10.1097/00007890-198401000-00018. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES