[Prognostic value of the phytohemagglutinin intradermal reaction in patients in an intensive care unit].

Abstract

It is fundamental importance to have available a simple method for testing the resistance of patients admitted to an intensive care unit in order to modify treatment and, where applicable, monitor its effects. This study evaluated the response to intradermal injections of Phytohaemagglutinin (PHA) (Difco: 7.5 micrograms in 0.1 ml) in 71 patients. The principal results were as follows: In forty patients, reactive on admission, mortality was 17.5 per cent, whilst it was 71 per cent in thirty one non reacting patients (p less than 0.0001). Taking into consideration only the last tests performed, the relationship between non-reaction/death became even more significant: 10 per cent of the 40 reacting patients, as against 81 per cent in the 31 non-reacting patients (p less than 0.00000001). Association with study of the tuberculin test did not notably improve the sensitivity of the test (75% mortality in the case of non-reaction to both tests). By contrast, there was a correlation with serum albumin levels measured at the time of admission (33.4 plus or minus 2.6 for 29 survivors; 28.4 plus or minus 3.9 for the 19 patients who died) (p less than 001). Continuation of the study emphasised the importance of the technical protocol in the value of the results and the major influence of nutrition intake on the positivisation of tests. In conclusion, intradermal injections of PHA offer a simple and reliable method for the assessment of immune defences.