Anergy and the severely ill surgical patient.

Delayed hypersensitivity skin test reaction was evaluated using Multitest CMI, an implement which provides seven standardized antigens in a single application. Eighty-two patients requiring Total Parenteral Nutrition for a variety of conditions were studied. The incidence of anergy was 65%. Seven anergic patients died, but there were no deaths in the reactive group, this difference being significant (P = 0.04). There was a significant association of anergy with carcinoma (P = 0.007) and anergic patients with carcinoma had a significantly greater risk of dying than reactive patients without carcinoma (P = 0.038). Anergic patients also had significantly lower nutritional parameters of serum albumin (P = 0.04), transferrin (P less than 0.001), absolute lymphocyte count (P = 0.009) and mid-arm muscle circumference (P = 0.02) compared to the reactive group.