Circulating Immature Granulocytes With T-Cell Killing Functions Predict Sepsis Deterioration*

Guérin, Estelle; Orabona, Marie; Raquil, Marie-Astrid; Giraudeau, Bruno; Bellier, Rémy; Gibot, Sébastien; Béné, Marie‐Christine; Lacombe, Francis; Droin, Nathalie; Solary, Éric; Vignon, Philippe; Feuillard, Jean; Dalmay, François

doi:10.1097/ccm.0000000000000344

Cited by 88 publications

(92 citation statements)

References 64 publications

(66 reference statements)

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“…Such an association was not seen with band cells, which is in agreement with an earlier observation that levels of band cells do not predict patient mortality [27]; however, it is not in accord with a report that band cells, identified by the phenotypes CD10 dim and CD16 dim , predict sepsis deterioration [14]. An increase in the percentage of immature neutrophils, other than band cells, has been reported to discriminate complicated from uncomplicated sepsis [15], although researchers in another study claimed that these cells predict infection [16].…”

Section: Discussionsupporting

confidence: 82%

“…Using only one haematologist eliminates interobserver variations that may arise in cytological interpretations and in the staining methods that are important for the recognition of neutrophil progenitors and their discrimination from one another [14,22]. Differences in procedures used to identify immature neutrophils could explain why some investigators propose that the increased levels they observed in the circulation are an indication or prediction of bacterial infections [12,13,16], whereas others suggest that these levels have limited diagnostic application [8].…”

Section: Discussionmentioning

confidence: 99%

“…For example, the Sysmex XE-2100 (Sysmex Corporation, Kobe, Japan) and ADVIA (Siemens Healthcare, Tarrytown, NY, USA) analysers recognise promyelocytes, myelocytes and metamyelocytes as immature neutrophils but not band cells [16,36-38]. Whereas neutrophils expressing CD10 dim /CD16 dim are considered to be band cells [14], as far as we are aware comparable markers for myelocytes and metamyelocytes are currently unavailable. However, it is likely that this limitation will be overcome in the near future by a greater characterisation of the phenotype of myeloid progenitors [39].…”

Section: Discussionmentioning

confidence: 99%

“…We therefore investigated the relative merits of the WBC criteria of Bone et al [2] and of Levy et al [3] in identifying patients with SIRS and whether monitoring levels of all forms of immature neutrophils could help in differentiating patients with N-I SIRS from those with sepsis. It was recently shown in patients with septic shock that increased mortality was related to WBC counts [20] and that in patients with sepsis an increase in the number of immature neutrophils reflected disease severity and predicted patient deterioration [14,15]. On this basis, we also examined whether levels of immature neutrophils had a bearing on patient outcome.…”

Section: Introductionmentioning

confidence: 96%

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

et al. 2015

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IntroductionIn 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.MethodsBlood 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.ResultsWith 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%).ConclusionsRaised 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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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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

et al. 2015

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“…Their role in human sepsis is unclear. Their presence is associated with lymphopenia and increased mortality (32). …”

Section: Resultsmentioning

confidence: 99%

Immune Cell Phenotype and Function in Sepsis

Rimmelé

Payen²,

Cantaluppi³

et al. 2016

Shock

151

119

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Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis. The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of non extracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed. A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8 and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes and the cell function.

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Sepsis

Shankar-Hari

Singer

2017

Inflammation - From Molecular and Cellular Mechanisms to the Clinic

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Circulating Immature Granulocytes With T-Cell Killing Functions Predict Sepsis Deterioration*

Abstract: Circulating immature granulocytes predicted early sepsis deterioration and were enriched in myeloid-derived suppressor cells which could be responsible for immunosuppression through the induction of T-cell lymphopenia.

Cited by 88 publications

References 64 publications

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

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

Immune Cell Phenotype and Function in Sepsis

Sepsis

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