NEUTROPHIL FUNCTION IN SURGICAL PATIENTS - 2 INHIBITORS OF GRANULOCYTE CHEMOTAXIS ASSOCIATED WITH SEPSIS

Two hundred fifty-four surgical patients were studied of whom 69% had a poor clinical outcome which correlated with skin test anergy and decreased polymorphonuclear neutrophil (PMN) chemotaxis (CTX). Patients demonstrating decreased PMN chemotaxis of less than 115 ± 1.0 μm (normal chemotaxis ± 95% confidence limits equaled 128.4 ± 4.4 μm) and skin test anergy (A) had a rate of sepsis equal to 66% and mortality of 37% compared to no sepsis or mortality in patients with normal CTX and normal skin test response. Of 170 A patients, 94% demonstrated decreased autologous PMN CTX. One hundred eleven sera from this pool were tested and all were found to decrease normal heterologous PMN CTX. This chemotactic inhibiting activity was due to two inhibitors circulating in sera from patients with anergy. One inhibitor was found in all sera and has pI = 6.2, s20,w = 5.3, and MW = 110,000. The other was found only in anergic sera and has pI = 4.6, s20,w = 9.4, MW = 310,000. The data suggest that the decreased PMN CTX observed in anergy is due to the de novo appearance of the larger PMN CTX inhibitor and that decreased PMN CTX and skin test anergy correlate highly with increased sepsis and mortality in the surgical patient. © 1979.