Sedimentation characteristics of leucocytes can predict bacteraemia in critical care patients: Figure 1

Abstract

Background: Early detection of blood stream infection can be lifesaving, but the results of blood cultures are not usually available before 24 hours after blood sampling. An earlier indication would lead to the initiation of immediate and adequate antibiotic treatment with obvious advantages for the patient. Objective: To evaluate the ability of leucocyte count, serum procalcitonin (PCT) concentration, erythrocyte sedimentation rate (ESR), and leucocyte antisedimentation rate (LAR) in predicting the blood culture results in critical care patients. Methods: 39 consecutive patients with their first febrile episode were investigated prospectively. LAR was determined as the percentage of leucocytes crossing the midline of a blood column upward during one hour of gravity sedimentation. The relevance of the different variables was estimated by likelihood ratio tests and area under receiver operating characteristic curves (AUC). Results: 23 patients had positive blood culture results and 16 negative. LAR was significantly higher in bacteraemic patients than in non-bacteraemic patients (p = 0.001), but leucocyte count, ESR and PCT level failed to show significant differences. Leucocyte count, PCT, and ESR yielded low discriminative values with the AUCs of 0.66, 0.64, and 0.52, respectively. LAR provided a likelihood ratio of 3.6 and an AUC of 0.80 (95% confidence interval, 0.64 to 0.95) (p = 0.002). Conclusions:The simple LAR test can predict blood culture results and support urgent treatment decisions in critical care patients in their first febrile episode.

New Approaches to Sepsis: Molecular Diagnostics and Biomarkers

“…Other conventional laboratory signs of sepsis, such as lactate, blood glucose, or thrombocyte counts, which are sensitive and easy to measure, are also very nonspecific (148). For example, the commonly used laboratory parameter of leukocytosis has very low sensitivity and specificity for the diagnosis of infection, with a likelihood ratio of 1.5; band counts have a similarly low diagnostic accuracy (25,66,187). The diagnostic uncertainty may explain why physicians find it difficult to define the disease and to communicate about it with patients and relatives (232).…”

Deficient leucocyte antisedimentation is related to post-stroke infections and outcome

“…LAR was previously reported in the critical care setting as a novel method for detecting activation of circulating leucocytes that can be the earliest sign of systemic inflammatory response syndrome 22. Here, we found that an early activation of leucocytes occurs during acute cerebrovascular events, since patients with both definitive stroke and TIA had significantly higher LAR compared to healthy controls as early as 6 hours after the onset of symptoms.…”

“…LAR correlated significantly with serum procalcitonin (PCT) and C-reactive protein (CRP) concentration in critically ill patients with severe sepsis 21. The simple LAR test was a good positive predictor of bacteraemia in critically ill patients presenting their first febrile episode without preceding antibiotic treatment 22 23…”

Serum procalcitonin level and leukocyte antisedimentation rate as early predictors of respiratory dysfunction after oesophageal tumour resection

“…A Bonferroni correction was calculated for each group of comparisons. The number of patients required was calculated by power analysis according to LAR results from our previous study, performed on a similar population, in which a LAR greater by 15% (standard deviation 9%) showed a 91% sensitivity of predicting blood culture positivity [9]. With type I α = 5% and with type II (power) of 90%, we therefore needed 32 patients.…”