Lack of Cytokine-Induced Skin Reaction Correlates With Acute Physiology Score and Mortality in Patients Receiving Intensive Care

• Because the majority of patients receiving intensive care are anergic to ubiquitous skin test antigens, prediction of clinical outcome cannot be based on their delayed-type hypersensitivity score, which is 0, but which is also a strong indicator of sepsis-related mortality in the preoperative patient. However, a cytokine-rich supernatant generated in the mixed lymphocyte culture reaction is able to induce an early skin reaction that peaks at 12 hours and wanes by 24 hours in some, but not all, anergic patients. Assessment of the clinical course of these patients demonstrated that only three of 25 patients who had a skin reaction larger than 5 mm died, compared with ten of 16 patients who failed to display this early reaction. Further analysis showed that both the cytokine-induced reaction and the acute physiology score significantly and independently contributed to the probability of death in anergic patients. These data suggest that the ability to generate a local inflammatory response to cytokines in anergic patients identifies a subpopulation of patients who have maintained some host-defense responsiveness and this response can be utilized to predict outcome.

(Arch Surg 1988;123:1474-1476)