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Invited Critique
September 2002

Decreased Cytokine Expression in Peripheral Blood Leukocytes of Patients With Severe Sepsis—Invited Critique

Arch Surg. 2002;137(9):1043. doi:10.1001/archsurg.137.9.1043

Modern surgical therapy can restore function to most patients, including many with disabling maladies. Yet, what is there about the presence of infection in these patients that occasionally leads to multiple organ failure and poor outcome?

Once patients become severely infected, their demographics for adverse outcome (age, sex, comorbidities, etc) are reasonably well captured by severity scoring systems. The report by Cabioglu et al supports this concept. Their article also reiterates the theme that outcome prediction can be enhanced (almost in real time) by the analysis of immune cell phenotype. Although their results are at some variance with those of previous reports in this journal,1,2 Cabioglu and colleagues surmise that adverse clinical outcome correlates with an attenuation of immune cell proinflammatory mediator influence (TH1) compared with the TH2 phenotype. Unfortunately, the authors neither address the methodological and data variances from previous reports nor provide much in the way of mechanistic discussion as to how this immunological "anergy" (their term) develops or resolves.