Neutrophil Chemiluminescence in Burned Patients

Phagocytic and bactericidal assays showed that a close correlation was present between bactericidal activity and neutrophil chemiluminescence (PMN-CL) (r = 0.81; p < 0.01). This suggested that the microbicidal action of the neutrophil depends metabolically on the generation of oxygenating agents. PMN-CL and opsonic index (OI) were measured in 36 burned patients. The levels of serum transferrin (Tf) were examined simultaneously by nephelometric method in order to determine the correlation between humoral-phagocyte axis of immune system and nutritional status. It was found that PMN-CL and OI were generally lower in the greater than 35% TBSA burn group (PMN-CL, 1.85 ± 0.21 cpm × 103, OI, 0.69 ± 0.06) compared with control subjects (PMN-CL, 3.55 ± 0.15 cpm × 103, OI, 1.05 ± 0.04). It suggested that both neutrophil oxygenation activity and opsonic activity were impaired following severe burns. PMN-CL was higher in the smaller than 30% TBSA burn group during infection phase as compared with control subjects (5.61 ± 0.26 cpm × 103 vs. 3.55 ± 01.5 cpm × 103p < 0.01). It remained high in patients with persistent infection, but fell to normal if appropriate therapy was instituted. This result indicated that the neutrophils of the majority of patients with minor buras during acute infection were in an activated state both metabolically and functionally. The occurrence of sepsis was associated with a marked lowering of PMN-CL and OI values, but no difference was noted before and after the development of sepsis. The incidence of sepsis was 85.7% when PMN-CL was lower than 2 cpm × 103. PMN-CL was lower when the sepsis was due to Pseudomonas aeruginosa than with Staphylococcus (1.45 ± 0.23 vs. 3.08 ± 0.54 cpm × 103, p < 0.01). A close correlation was also found between PMN-CL and OI (r = 0.68) as well as PMN-CL and the levels of serum transferrin (r = 0.64; p < 0.01). It is tentatively concluded from this study that PMN-CL may provide a rapid, sensitive, noninvasive, and objective method for assessment of both aspects of the humoral-phagocyte immunity. Its measurement would be useful to alert physicians to an impending sepsis and prompt a thorough search for its source and early administration of appropriate treatment.