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Reviewing the value of leukocytes cell population data (CPD) in the management of sepsis.

ABSTRACT: Sepsis is a medical emergency that describes the body's systemic immune response to an infection and can lead to end-stage organic dysfunction and death. Despite the advances in understanding the pathophysiology of this syndrome and therapies, sepsis remains one of the leading causes of morbidity and mortality in critically ill patients. Early diagnosis and rapid intervention are essential to improve outcomes, which inspired the concept "golden hour," during which the correction of shock and organic dysfunction can improve the patients' outcomes. But the initial presentation of sepsis is often nonspecific and its severity is difficult to assess. Anomalies in temperature, heart and respiratory rates and leukocyte counts are manifestations of systemic inflammatory response syndrome (SIRS). Diagnosis, management and follow-up of patients with sepsis remains a challenge, and diverse biomarkers have been proposed for the timely diagnosis and prognosis of septic patients: lactic acid, procalcitonin (PCT), C-reactive protein, immature granulocytes. The host's initial response to infection is a humoral, cellular and neuroendocrine reaction to infection, and leukocytes interact with endothelial cells. The new generation of hematological analyzers incorporates technological innovations allowing to expand the information derived from the complete blood count: new leukocyte derived parameters are emerging as potentially useful markers in different clinical situations. Additional research parameters cell population data (CPD), characterizing different leukocyte populations have become available, and preliminary observations suggest their utility in the diagnosis of sepsis. This review emphasizes the value of CPD, reported by modern cellular counters for early recognition of sepsis, and therefore the potential improvement in patient outcomes.

SUBMITTER: Urrechaga E

PROVIDER: S-EPMC7475430 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Reviewing the value of leukocytes cell population data (CPD) in the management of sepsis.

Urrechaga Eloísa E

Annals of translational medicine 20200801 15

Sepsis is a medical emergency that describes the body's systemic immune response to an infection and can lead to end-stage organic dysfunction and death. Despite the advances in understanding the pathophysiology of this syndrome and therapies, sepsis remains one of the leading causes of morbidity and mortality in critically ill patients. Early diagnosis and rapid intervention are essential to improve outcomes, which inspired the concept "golden hour," during which the correction of shock and org ...[more]

PMID: 32953753

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Project description:BACKGROUND:The use of in vivo videomicroscopy at the bedside has demonstrated microcirculatory flow disturbances in sepsis. The ability of in vivo videomicroscopy to detect changes in the prevalence of rolling and adhered leukocytes that occur in sepsis is not well-described in humans. We sought to (1) develop methodology for accessing and quantifying sublingual leukocyte rolling and adherence with sidestream dark field (SDF) imaging; (2) compare the number of rolling and adhered leukocytes between patients with septic shock and non-infected controls; and (3) compare the number of rolling and adhered leukocytes between survivors and non-survivors of septic shock. METHODS:We included adult (age?>?18 years) patients in the emergency department presenting with septic shock prospectively enrolled in the ProCESS trial. We recruited comparison non-infected patients as emergency department controls. Using a SDF videomicroscope, we obtained image sequences from the sublingual mucosa, quantifying rolling and adhered leukocytes per 1 mm?×?1 mm visual field in a standardized 3-s clip. We report data as median and interquartile range and depicted as box plots. We compared groups using the Mann-Whitney U test, considering a p value <?0.05 significant. RESULTS:We included a total of 64 patients with septic shock and 32 non-infected controls. The median number of adhered leukocytes per field in the sepsis group was 1.0 (IQR 0-3.5) compared to 0 (0-0) in the non-infected group (p?<?0.001). The median number of rolling leukocytes was 26 (10.3-42) in the sepsis group and 9.8 (4.8-17.3) in the non-infected group (p?<?0.001) per field. Among the patients with sepsis (n?=?64), there was an increased number of adhered leukocytes in non-survivors compared to survivors (3.0 (1-5.5) vs. 1.0 (0-3.0)) (p?<?0.05); however, there was no difference in rolling leukocytes (35 (20-48) vs. 26 (10-41)) (p?=?0.31). CONCLUSIONS:Our results demonstrated a higher number of rolling and adhered leukocytes in patients with septic shock when compared to non-infected controls, and an increased number of adhered leukocytes in non-survivors. TRIAL REGISTRATION:ClinicalTrials.gov , NCT00793442 ; Registered on 19 November 2008 PG0GM076659 (US NIH Grant/Contract). First submitted 18 July 2007. First posted 2 August 2007.

Dataset Information

Reviewing the value of leukocytes cell population data (CPD) in the management of sepsis.

Publications

Reviewing the value of leukocytes cell population data (CPD) in the management of sepsis.

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