Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the Multitest© CMI

TY - JOUR

T1 - Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the Multitest© CMI

AU - Beier-Holgersen, R

AU - Brandstrup, B

PY - 1999

Y1 - 1999

N2 - BACKGROUND: Patients who become anergic after surgery have a very high death rate, mainly due to infectious complications. It has earlier been shown that preoperative skin testing has predictive value for the clinical outcome in gastrointestinal surgery. This study investigated the effect of early postoperative enteral nutrition versus placebo on cell-mediated immunity with the Multitest CMI and correlated the results to the clinical outcome and to the preoperative nutritional status.METHODS: Sixty patients were randomized to receive either enteral nutrition or placebo. All patients were stratified in accordance with preoperative nutritional status. CMI tests were applied 2 days before surgery and days 1 and 5 postoperatively. All tests were applied and recorded by the same investigator.RESULTS: No significant differences in the score were seen between the groups. Nine patients were malnourished. No significant difference was seen preoperatively with regard to nutritional status, but the malnourished patients had a lower median value on the 3rd postoperative day. In patients with complications the preoperative median CMI score was 17.0 mm (95% confidence limits, 10.5-24 mm), and in patients without complications 9.5 mm (95% confidence limits, 5.5-16 mm). This result is significant and unexpected. Ten patients were anergic preoperatively, and three of these developed complications (30%). The overall complication rate was 27 of 60 (45%). A change in immunologic status from responding preoperatively to anergy postoperatively was significantly associated with severe complications (P = 0.043).CONCLUSIONS: Early enteral nutrition does not influence the CMI score. Preoperative anergy was not related to increased mortality/morbidity, whereas the change in CMI response towards anergy was significant.

AB - BACKGROUND: Patients who become anergic after surgery have a very high death rate, mainly due to infectious complications. It has earlier been shown that preoperative skin testing has predictive value for the clinical outcome in gastrointestinal surgery. This study investigated the effect of early postoperative enteral nutrition versus placebo on cell-mediated immunity with the Multitest CMI and correlated the results to the clinical outcome and to the preoperative nutritional status.METHODS: Sixty patients were randomized to receive either enteral nutrition or placebo. All patients were stratified in accordance with preoperative nutritional status. CMI tests were applied 2 days before surgery and days 1 and 5 postoperatively. All tests were applied and recorded by the same investigator.RESULTS: No significant differences in the score were seen between the groups. Nine patients were malnourished. No significant difference was seen preoperatively with regard to nutritional status, but the malnourished patients had a lower median value on the 3rd postoperative day. In patients with complications the preoperative median CMI score was 17.0 mm (95% confidence limits, 10.5-24 mm), and in patients without complications 9.5 mm (95% confidence limits, 5.5-16 mm). This result is significant and unexpected. Ten patients were anergic preoperatively, and three of these developed complications (30%). The overall complication rate was 27 of 60 (45%). A change in immunologic status from responding preoperatively to anergy postoperatively was significantly associated with severe complications (P = 0.043).CONCLUSIONS: Early enteral nutrition does not influence the CMI score. Preoperative anergy was not related to increased mortality/morbidity, whereas the change in CMI response towards anergy was significant.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Digestive System Surgical Procedures/adverse effects

KW - Double-Blind Method

KW - Enteral Nutrition

KW - Female

KW - Humans

KW - Immunity, Cellular/immunology

KW - Male

KW - Middle Aged

KW - Nutrition Disorders/diet therapy

KW - Nutritional Status/immunology

KW - Postoperative Period

KW - Prospective Studies

KW - Reagent Kits, Diagnostic

KW - Treatment Outcome

U2 - 10.1080/00365529950172907

DO - 10.1080/00365529950172907

M3 - Journal article

C2 - 10048740

SN - 0085-5928

VL - 34

SP - 98

EP - 102

JO - Scandinavian Journal of Gastroenterology. Supplement

JF - Scandinavian Journal of Gastroenterology. Supplement

IS - 1

ER -