Early Flow Cytometry Predictive of Clinical Deterioration in Sepsis
Immature granulocytes percentages tended to be higher in patients whose clinical status worsened on day 2.
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.
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