Neutrophil Function in Anergic Surgical Patients

Skin test anergy (A) to recall antigens identifies surgical patients at high risk for sepsis. We studied neutrophil function 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 Boyeden technique. Twenty-one laboratory controls had a neutrophil adherence of 71.5 +/- 3.8% (mean +/-SD) and chemotaxis of 128.1 +/- 2.4,micro (mean +/-SD). Fifty-four hospitalized patients with normal skin tests had neutrophil adherence of 72.5 +/- 13.1% (p ~ 0.5 relative to control) and chemotaxis of 123.3 +/- 3.1 micro (p ~ 0.5). Twenty three relatively anergic patients had values of 84.3 +/- 7.9% (p < 0.001) and 103.7 +/- 2.0 micro (p < 0.001). Forty five A patients had adherence of 85.0 +/- 7.0% (p < 0.001) and chemotaxis of 90.4 +/- 2.9 micro (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 have been shown in both serum and plasma of patients with decreased autologous neutrophil chemotaxis. We propose that this altered neutrophil function (possibly with other defects) in anergic patients may compromise their host defenses and render them susceptible to infection.