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[Cell-mediated immunity studied by skin tests in patients receiving intensive care. Prognostic value of repeated tests. Study of some factors predisposing towards anergy (author's transl)].

Cell-mediated immunity was assessed by three skin tests (using tuberculin, candidin, and Varidase) in one-hundred patients in a medical intensive care unit. Anergy on admission was most often found after major blood loss and massive transfusion as well as in patients over sixty. For the 49 patients who were anergic on admission the mortality rate was 32%, against 12% for the 51 reactive subjects (p less than 0.01). Repetition of skin tests considerably improved their prognostic value. No deaths occurred among the 21 patients who were reactive on admission and throughout the course of their disease, or among the 16 patients who, after being anergic on admission, became reactive subsequently. Conversely, the survival rate was only 40% for the 22 patients who remained or became anergic. Our results confirm the value of skin tests for assessing cell-mediated immunity in patients receiving intensive care. Repeated tests allow early detection of high risk patients in whom fatal outcome, whether due to infection or not, is more frequent. Two factors which predispose to anergy are underlined: advanced age and massive transfusion after major blood loss.