Biochemical and Hematological Markers of Inflammation Accurately Predict Sepsis and its Severity in ICU Patients

• Biochemical and Hematological Markers of Inflammation Accurately Predict Sepsis and its Severity in ICU Patients

AUTHOR(S)

A. WOODWORTH*¹, M. A. THOMPSON*², T. RICE*² and S. BISSONNETTE*³

*1 University of Kentucky Medical Center
*2 Vanderbilt University Medical Center
*3 Marshfield Clinic Health System

SUMMARY

Sepsis has long been considered a major health crisis, striking more than 1.5 million Americans each year. It is also one of the leading causes of death in hospitalized patients, killing more than 250,000 people annually in the U.S., equating to one person every two minutes. The complex pathobiology and expansive reach to most organ systems in the body make sepsis an extremely dangerous disease. Considering the severity of sepsis and new regulatory requirements, rapid diagnosis and treatment has become a major area of focus for emergency department and Intensive Care Unit clinicians. As a result, researchers have turned to investigating groups of clinical tests to effectively diagnose or predict the onset of sepsis.

A study performed at Vanderbilt University Medical Center (VUMC) examined the use of hematologic parameters (including WBC, RBC, platelets, ANC and IG), procalcitonin (PCT), and CRP for predicting sepsis among SIRS patients. Receiver operator characteristic (ROC) curves were generated to evaluate various sepsis diagnostic models using the hematological and biomarker results collected one or two days prior to the patient developing symptoms of systemic inflammation. The area under the ROC curve (AUC) when using only hematology parameters to predict sepsis ranged from 0.51 to 0.66. When looking at procalcitonin and C-reactive protein only, the AUC increased to 0.70 and 0.73, respectively. When the absolute neutrophil count (ANC) and IG count were combined with the inflammatory biomarkers, the AUC increased to 0.74, showing good predictive ability to identify sepsis in patients before the onset of systemic inflammatory symptoms. Additionally, when trying to predict which patients would develop severe sepsis or septic shock, this same combination of hematologic and inflammatory biomarkers gave an AUC of 0.77. The VUMC study, current literature, and changing guidelines demonstrate that the bedside physical examination along with laboratory testing (to include hematologic and inflammatory biomarkers) are the most effective combination of parameters that clinicians currently have to rapidly and accurately predict or diagnose sepsis in a critically ill patient.

KEY WORDS

Sepsis, Systemic Inflammatory Response Syndrome, SIRS, Inflammation, Intensive Care Unit, Immature Neutrophils, Immature Granulocyte Count, IGC, IG, Automated Differential, Hematology, White Blood Cell, Sysmex.

NOTE(S)

This article is based on current regulatory requirements in the U.S.A., Canada and Latin America as applicable. (as of Feb. 2019)
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