Early Flow Cytometry Predictive of Clinical Deterioration in Sepsis

Immature granulocytes (IG) are a biologic marker of severity in the early phase of sepsis and quantifying circulating IG using early flow cytometry could help clinicians target patients with sepsis who are at a high risk for clinical deterioration, according to new findings published in Chest.

The authors note that a biologic marker predictive of sepsis progression in critically ill patients would be highly valuable in the intensive care setting. In this study, they assessed flow cytometry as a predictive tool for early clinical deterioration and overall survival in patients with sepsis who were admitted to the emergency department and intensive care unit.

The multicenter study (ClinicalTrials.gov identifier: NCT01995448) included 781 consecutive patients with confirmed sepsis (sepsis: n=343; severe sepsis: n=192; septic shock: n=246). Patients who had less than 30% circulating IG had a 95% overall survival rate at day 28, whereas percentages of circulating IG above 30% at the early phase of sepsis were significantly linked with the probability of death by day 28 (19.6 ± 17 vs 56.5 ± 42.4; P <.01). The severity of illness was associated with higher percentages of IG and deeper T-cell lymphopenia, and increased IG percentages, and especially when associated with T-cell lymphopenia, were independently associated with both early (P <.01) and late (P <.01) mortality. Overall, higher percentages of circulating CD16dim IG on admission to the hospital were significantly associated with sepsis severity.

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The authors concluded that in the near future, “routine quantification of circulating IG using early flow cytometry could help front-line clinicians in predicting the outcome of patients with acute sepsis both in the emergency department and in the intensive care unit.”


Daix T, Guerin E, Tavernier E, et al; Septiflux trial group. Multicentric standardized flow cytometry routine assessment of septic patient to predict clinical worsening [published online April 26, 2018]. Chest. doi: 10.1016/j.chest.2018.03.058