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The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation.

Mare TA, Treacher DF, Shankar-Hari M, Beale R, Lewis SM, Chambers DJ, Brown KA - Crit Care (2015)

Bottom Line: Blood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects.Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).Raised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. tracey.1.mare@kcl.ac.uk.

ABSTRACT

Introduction: In this cohort study, we investigated whether monitoring blood levels of immature neutrophils (myelocytes, metamyelocytes and band cells) differentiated patients with sepsis from those with the non-infectious (N-I) systemic inflammatory response syndrome (SIRS). We also ascertained if the appearance of circulating immature neutrophils was related to adverse outcome.

Methods: Blood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects. Clinical and laboratory staff were blinded to each other's results, and patients were retrospectively characterised into those with SIRS (n = 122) and those without SIRS (n = 14). The patients with SIRS were further subdivided into categories of definite sepsis (n = 51), possible sepsis (n = 32) and N-I SIRS (n = 39). Two established criteria were used for monitoring immature white blood cells (WBCs): one where band cells >10% WBCs and the other where >10% of all forms of immature neutrophils were included but with a normal WBC count. Immature neutrophils in blood smears were identified according to nuclear morphology and cytoplasmic staining.

Results: With the first criterion, band cells were present in most patients with SIRS (mean = 66%) when compared with no SIRS (mean = 29%; P <0.01) and with healthy subjects (0%). The prevalence of band cells was higher in definite sepsis (mean = 82%) than in patients with possible sepsis (mean = 63%; P <0.05) or with N-I SIRS (mean = 39%; P <0.001), and they had a sensitivity of 84% and a specificity of 71% for the detection of definite sepsis. With the second criterion (that is, patients with normal WBC counts), we noted that immature neutrophils did not differentiate any of the patient groups from one another. Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).

Conclusions: Raised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.

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Related in: MedlinePlus

Levels of band cells are indirectly related to the numbers of platelets in patients with definite sepsis. Relationships were sought between the percentage of band cells and (A) platelet numbers, (B) white blood cell (WBC) count, (C) C-reactive protein (CRP) concentration and (D) patient age. Correlations were assessed by linear regression analysis and the Pearson’s correlation coefficient. The percentage of band cells was inversely related to the platelet count (R2 = 0.08, *P = 0.04), but no other relationships were observed.
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Fig4: Levels of band cells are indirectly related to the numbers of platelets in patients with definite sepsis. Relationships were sought between the percentage of band cells and (A) platelet numbers, (B) white blood cell (WBC) count, (C) C-reactive protein (CRP) concentration and (D) patient age. Correlations were assessed by linear regression analysis and the Pearson’s correlation coefficient. The percentage of band cells was inversely related to the platelet count (R2 = 0.08, *P = 0.04), but no other relationships were observed.

Mentions: To determine if an increase in band cell distribution was associated with standard laboratory measurements of infection and inflammation, band cell levels in patients with definite sepsis were compared with the total WBC counts, platelet numbers and C-reactive protein (CRP) values. We also examined whether band cell levels were related to patient age. Figure 4 shows that the percentage of band cells was indirectly associated with the number of platelets, but not with the total WBC count, CRP concentration or patient age. Of the patients with definite sepsis, 55% had an abnormal WBC count, 23% had thrombocytopenia (that is, platelet count <150 × 109/L) and 97% had a raised CRP level (>5 μg/ml). Unlike the levels of band cells, neither WBC numbers, nor platelet counts nor CRP concentrations differentiated patients with sepsis from patients with N-I SIRS.Figure 4


The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation.

Mare TA, Treacher DF, Shankar-Hari M, Beale R, Lewis SM, Chambers DJ, Brown KA - Crit Care (2015)

Levels of band cells are indirectly related to the numbers of platelets in patients with definite sepsis. Relationships were sought between the percentage of band cells and (A) platelet numbers, (B) white blood cell (WBC) count, (C) C-reactive protein (CRP) concentration and (D) patient age. Correlations were assessed by linear regression analysis and the Pearson’s correlation coefficient. The percentage of band cells was inversely related to the platelet count (R2 = 0.08, *P = 0.04), but no other relationships were observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4355545&req=5

Fig4: Levels of band cells are indirectly related to the numbers of platelets in patients with definite sepsis. Relationships were sought between the percentage of band cells and (A) platelet numbers, (B) white blood cell (WBC) count, (C) C-reactive protein (CRP) concentration and (D) patient age. Correlations were assessed by linear regression analysis and the Pearson’s correlation coefficient. The percentage of band cells was inversely related to the platelet count (R2 = 0.08, *P = 0.04), but no other relationships were observed.
Mentions: To determine if an increase in band cell distribution was associated with standard laboratory measurements of infection and inflammation, band cell levels in patients with definite sepsis were compared with the total WBC counts, platelet numbers and C-reactive protein (CRP) values. We also examined whether band cell levels were related to patient age. Figure 4 shows that the percentage of band cells was indirectly associated with the number of platelets, but not with the total WBC count, CRP concentration or patient age. Of the patients with definite sepsis, 55% had an abnormal WBC count, 23% had thrombocytopenia (that is, platelet count <150 × 109/L) and 97% had a raised CRP level (>5 μg/ml). Unlike the levels of band cells, neither WBC numbers, nor platelet counts nor CRP concentrations differentiated patients with sepsis from patients with N-I SIRS.Figure 4

Bottom Line: Blood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects.Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).Raised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. tracey.1.mare@kcl.ac.uk.

ABSTRACT

Introduction: In this cohort study, we investigated whether monitoring blood levels of immature neutrophils (myelocytes, metamyelocytes and band cells) differentiated patients with sepsis from those with the non-infectious (N-I) systemic inflammatory response syndrome (SIRS). We also ascertained if the appearance of circulating immature neutrophils was related to adverse outcome.

Methods: Blood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects. Clinical and laboratory staff were blinded to each other's results, and patients were retrospectively characterised into those with SIRS (n = 122) and those without SIRS (n = 14). The patients with SIRS were further subdivided into categories of definite sepsis (n = 51), possible sepsis (n = 32) and N-I SIRS (n = 39). Two established criteria were used for monitoring immature white blood cells (WBCs): one where band cells >10% WBCs and the other where >10% of all forms of immature neutrophils were included but with a normal WBC count. Immature neutrophils in blood smears were identified according to nuclear morphology and cytoplasmic staining.

Results: With the first criterion, band cells were present in most patients with SIRS (mean = 66%) when compared with no SIRS (mean = 29%; P <0.01) and with healthy subjects (0%). The prevalence of band cells was higher in definite sepsis (mean = 82%) than in patients with possible sepsis (mean = 63%; P <0.05) or with N-I SIRS (mean = 39%; P <0.001), and they had a sensitivity of 84% and a specificity of 71% for the detection of definite sepsis. With the second criterion (that is, patients with normal WBC counts), we noted that immature neutrophils did not differentiate any of the patient groups from one another. Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).

Conclusions: Raised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.

Show MeSH
Related in: MedlinePlus