{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:09:50Z","timestamp":1784819390455,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[1995,9,1]],"date-time":"1995-09-01T00:00:00Z","timestamp":809913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[1995,9]]},"abstract":"<jats:p><jats:italic>Background:<\/jats:italic> Immunosuppression after severe head injury has been characterized by a depressed CD4 (T\u2010helper\/inducer)\u2010CD8 (T\u2010suppressor\/cytotoxic) ratio and decreased T\u2010lymphocyte responsiveness. Some investigators propose that this immunocompromized state is the result of an injury\u2010associated hypermetabolic response and inadequate nutrient delivery during the immediate postinjury recovery phase. Previous observations from our institution demonstrated a preserved CD4\u2010CD8 ratio in severe closed\u2010head 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. <jats:italic>Methods:<\/jats:italic> 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\u2010lymphocyte expression of CD4 and CD8 cell surface antigens and interleukin\u20106 was performed on days 1, 3, 7, and 14 of hospitalization. T\u2010lymphocyte activation in response to stimulation by concanavalin A (Con A), phytohemagglutinin (PHA), and pokeweed mitogens (PWM) was also assessed on these days. <jats:italic>Results:<\/jats:italic> Significant increases in total CD4 cell counts (2048 \u00b1 194 to 2809 \u00b1 129 vs 1728 \u00b1 347 to 1825 \u00b1 563, <jats:italic>p<\/jats:italic> &lt;.05) and CD4% (42.6 \u00b1 4.4% to 56.2 \u00b1 2.6% vs 36.6 \u00b1 6.6% to 36.6 \u00b1 11.3%, <jats:italic>p<\/jats:italic> &lt;.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 \u00b1 1596 to 16144 \u00b1 5024 cpm, <jats:italic>p<\/jats:italic> &lt;.05). A significant rise in the CD4\u2010CD8 ratio over baseline to day 14 was also noted in the early PN group (1.43 \u00b1 0.17 to 2.38 \u00b1 0.54, <jats:italic>p<\/jats:italic> &lt;.05). <jats:italic>Conclusions:<\/jats:italic> The early aggressive nutrition support of CHI patients appears to modify immunologic function by increasing CD4 cells, CD4\u2010CD8 ratios, and T\u2010lymphocyte responsiveness to Con A. (<jats:italic>Journal of Parenteral and Enteral Nutrition<\/jats:italic> <jats:bold>19:<\/jats:bold>387\u2013392, 1995)<\/jats:p>","DOI":"10.1177\/0148607195019005387","type":"journal-article","created":{"date-parts":[[2008,5,14]],"date-time":"2008-05-14T19:51:26Z","timestamp":1210794686000},"page":"387-392","source":"Crossref","is-referenced-by-count":58,"title":["Early Nutrition Support Modifies Immune Function in Patients Sustaining Severe Head Injury"],"prefix":"10.1002","volume":"19","author":[{"given":"Gordon S.","family":"Sacks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rex O.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Teague","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland N.","family":"Dickerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Tolley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A.","family":"Kudsk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[1995,9]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198811000-00009"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.5.0766"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199007000-00001"},{"key":"e_1_2_1_5_1","first-page":"202","article-title":"The significance of immunosuppression and hormonal alteration in neurotraumatology","volume":"8","author":"Lin CN","year":"1992","journal-title":"Kaohsiung J Med Sci"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1994.01420250078010"},{"key":"e_1_2_1_7_1","first-page":"505","volume-title":"Fundamentals of Biostatistics","author":"Rosner B.","year":"1986"},{"key":"e_1_2_1_8_1","first-page":"644","article-title":"A rate sensing approach to urea measurement","volume":"17","author":"Paulson G.","year":"1971","journal-title":"Clin Chem"},{"key":"e_1_2_1_9_1","first-page":"2","article-title":"The routine isolation of blood\u2010cell populations by centrifugation using single\u2010step density barriers","volume":"15","author":"Ford TC","year":"1993","journal-title":"Focus"},{"key":"e_1_2_1_10_1","first-page":"223","article-title":"Nutrition in the neurologically injured patient","volume":"6","author":"Ott L.","year":"1991","journal-title":"NCP"},{"key":"e_1_2_1_11_1","first-page":"725","article-title":"Excessive nitrogen losses in severe brain injury","volume":"16","author":"Boop FA","year":"1985","journal-title":"Neurosurgery"},{"key":"e_1_2_1_12_1","first-page":"388","article-title":"Physiological and metabolic response to isolated closed\u2010head injury. Part 2: Effects of steroids on metabolism","volume":"66","author":"Deutschman CS","year":"1987","journal-title":"Potentiation of protein wasting and abnormalities of substrate utilization. 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