Document 0615
 DOCN  M9650615
 TI    Early nutrition support modifies immune function in patients sustaining
       severe head injury.
 DT    9605
 AU    Sacks GS; Brown RO; Teague D; Dickerson RN; Tolley EA; Kudsk KA;
       Department of Clinical Pharmacy, University of Tennessee, Memphis;
       38163, USA.
 SO    JPEN J Parenter Enteral Nutr. 1995 Sep-Oct;19(5):387-92. Unique
       Identifier : AIDSLINE MED/96105875
 AB    BACKGROUND: Immunosuppression after severe head injury has been
       characterized by a depressed CD4 (T-helper/inducer)-CD8
       (T-suppressor/cytotoxic) ratio and decreased T-lymphocyte
       responsiveness. Some investigators propose that this immunocompromized
       state is the result of an injury-associated hypermetabolic response and
       inadequate nutrient delivery during the immediate postinjury recovery
       phase. Previous observations from our institution demonstrated a
       preserved CD4-CD8 ratio in severe closed-head injury (CHI) patients
       receiving early parenteral nutrition (PN). It was unclear whether early
       PN or other aspects of patient care eliminated the characteristic
       depression in cellular immunity. The purpose of this study was to
       further investigate the effect of early PN on the immune function of CHI
       patients. METHODS: Nine patients sustaining severe CHI were
       prospectively randomized to either early PN (n = 4) at day 1 or delayed
       PN (n = 5) at day 5. Total nutrient administration was delivered at 2 g
       of protein/kg per day and 40 nonprotein kcal/kg per day for at least the
       first 14 days of hospitalization. Analysis for T-lymphocyte expression
       of CD4 and CD8 cell surface antigens and interleukin-6 was performed on
       days 1, 3, 7, and 14 of hospitalization. T-lymphocyte activation in
       response to stimulation by concanavalin A (Con A), phytohemagglutinin
       (PHA), and pokeweed mitogens (PWM) was also assessed on these days.
       RESULTS: Significant increases in total CD4 cell counts (2048 +/- 194 to
       2809 +/- 129 vs 1728 +/- 347 to 1825 +/- 563, p < .05) and CD4% (42.6
       +/- 4.4% to 56.2 +/- 2.6% vs 36.6 +/- 6.6% to 36.6 +/- 11.3%, p < .05)
       were observed at day 14 in patients receiving early vs delayed PN. An
       improved lymphocyte response from baseline to day 14 after Con A
       stimulation was demonstrated in the early PN group (3850 +/- 1596 to
       16144 +/- 5024 cpm, p < .05). A significant rise in the CD4-CD8 ratio
       over baseline to day 14 was also noted in the early PN group (1.43 +/-
       0.17 to 2.38 +/- 0.54, p < .05). CONCLUSIONS: The early aggressive
       nutrition support of CHI patients appears to modify immunologic function
       by increasing CD4 cells, CD4-CD8 ratios, and T-lymphocyte responsiveness
       to Con A.
 DE    Adolescence  Adult  Aged  Concanavalin A/PHARMACOLOGY  CD4-CD8 Ratio
       Female  Head Injuries/COMPLICATIONS/*IMMUNOLOGY  Human  Injury Severity
       Score  Interleukin-6/BLOOD  Lymphocyte Transformation/DRUG EFFECTS  Male
       Middle Age  Parenteral Nutrition/*STANDARDS
       Phytohemagglutinins/PHARMACOLOGY  Plant Proteins/PHARMACOLOGY  Pokeweed
       Mitogens/PHARMACOLOGY  Prospective Studies  T-Lymphocytes/DRUG
       EFFECTS/IMMUNOLOGY  CLINICAL TRIAL  JOURNAL ARTICLE  RANDOMIZED
       CONTROLLED TRIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).