Immunological assessment and its predictive role in malnourished infants with diarrhoea and/or systemic infections.

Abstract

The Immune capacity of 47 marasmic 1–12 months old ill infants with weights below 75 per cent of Brazilian standards and of 12 well-nourished healthy controls was studied, by measuring: the absolute and relative T and B lymphocyte subpopulatioits, the blastogenic response to phytohaemagglutinin (PHA), expressed as stimulation index (SI), and the delayed hypersensitivity skin test with PHA. Eight (17 per cent) of the malnourished infants died and results were evaluated with respect to ultimate outcome. In addition a discriminant analysis was retrospectively applied to the immunological data of the two groups of malnourished infants.Both groups of malnourished infants presented significantly lower values than the control group for all measurements, although not very evident for B lymphocytes. The immunodepression was more intense for the infants who died than for those who survived, as shown by significantly lower values for the SI, the skin test, and by the discriminant analysis. The discriminant analysis led to a linear predictive model which accurately classified 85 per cent of the survivors and 100 per cent of those who died. It was con cluded that immunological parameters may be useful to select prospectively those infants who need a different therapeutic approach because of their high risk of mortality.