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

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• 作者：Tracey Anne Mare (1) (2)
  David Floyd Treacher (1) (2)
  Manu Shankar-Hari (1) (2)
  Richard Beale (1) (2)
  Sion Marc Lewis (1) (2) (4)
  David John Chambers (3)
  Kenneth Alun Brown (1) (2) (4)
  
  1. Intensive Care Unit ; Guy鈥檚 and St Thomas鈥?NHS Foundation Trust ; St Thomas鈥?Hospital ; Westminster Bridge Road ; London ; SE1 7EH ; UK
  2. Division of Asthma ; Allergy and Lung Biology ; Faculty of Life Sciences and Medicine ; King鈥檚 College London ; Great Maze Pond ; London ; SE1 9RT ; UK
  4. Vascular Immunology Research Laboratory ; Rayne Institute (King鈥檚 College London) ; St Thomas鈥?Hospital ; Westminster Bridge Road ; London ; SE1 7EH ; UK
  3. Cardiac Surgical Research ; The Rayne Institute (King鈥檚 College London) ; Guy鈥檚 and St Thomas鈥?NHS Foundation Trust ; St Thomas鈥?Hospital ; Westminster Bridge Road ; London ; SE1 7EH ; UK
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,387 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

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聽hours of ICU entry and from 20 healthy control subjects. Clinical and laboratory staff were blinded to each other鈥檚 results, and patients were retrospectively characterised into those with SIRS (n鈥?鈥?22) and those without SIRS (n鈥?鈥?4). The patients with SIRS were further subdivided into categories of definite sepsis (n鈥?鈥?1), possible sepsis (n鈥?鈥?2) and N-I SIRS (n鈥?鈥?9). 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鈥?鈥?6%) when compared with no SIRS (mean鈥?鈥?9%; P P SIRS (mean鈥?鈥?9%; P P 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.