The delayed hypersensitivity response and host resistance in surgical patients. 20 years later.

Objective: A 20-year follow-up was conducted on research into the implications of a lack of a delayed-type hypersensitivity (DTH) skin test response among surgical patients.

Summary Background Data: The authors' original report showed that a failed DTH response was associated with increased hospital mortality, but the role of specific and nonspecific host defense elements, comorbid factors, nutritional supplementation, and the mechanism for anergy in this adverse outcome was unknown.

Methods: A data base of 4292 patients was analyzed and reported on individual studies designed to answer some of the above questions.

Anabolic steroids and total parenteral nutrition.

Malnutrition develops rapidly with total starvation, especially when a catabolic stress is superimposed. The measurement of body composition provides an accurate and quantitative measurement of both the nutritional state and the response to nutritional therapy. With malnutrition there is a loss of body fat and BCM with a concomitant expansion of the ECM.

The effect of age on the caloric requirement of malnourished individuals.

The effect of age on the response to total parenteral nutrition (TPN) was evaluated in 325 patients by measuring body composition by multiple-isotope dilution at the onset and at 2-wk intervals during the course of TPN. On the basis of their initial body composition, patients were divided into two groups: normally nourished and malnourished. TPN did not alter the body composition of the normally nourished patients.

Parenteral and enteral nutrition.

Stress and starvation, especially when complicated by sepsis, will give rise to a rapid erosion of the cellular mass, which significantly affects morbidity and mortality. The best clinical evaluation of the nutritional state is obtained from the medical history and the physical examination. In the patient who cannot eat a balanced diet, specialized nutritional support, in the form of either enteral or parenteral nutrition, is required to prevent malnutrition in the normally nourished, or to correct the nutritional state in the malnourished.