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

Abstract

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.

Association of Presence of Band Cells and Toxic Neutrophils with Systemic Inflammatory Response Syndrome and Outcome in Horses with Acute Disease

“…In human medicine, an increased percentage of band neutrophils is also often viewed as a marker of acute and severe infection and has been associated with sepsis as well as early deterioration and poor outcome in septic patients . Indeed, band neutrophils were even included in the original human SIRS definition published in 1992 .…”

“…Findings in cats and dogs with DLS are similar, with DLS significantly associated with septic peritonitis and pyothorax in cats, 1 and with septic peritonitis, parvoviral enteritis, gastroenteritis excluding parvoviral enteritis, pancreatitis, and immune-mediated neutropenia in dogs. 6 In human medicine, an increased percentage of band neutrophils is also often viewed as a marker of acute and severe infection 19 and has been associated with sepsis 20 as well as early deterioration and poor outcome in septic patients. 21 Indeed, band neutrophils were even included in the original human SIRS definition published in 1992.…”

Human neutrophils in the saga of cellular heterogeneity: insights and open questions

“…Whatever the case is, the phenotypic and functional features of the LDNs to date described in various diseases are discussed below and summarized in Tables and . It must be pointed out that, despite the several unanswered questions on their features, there is a considerable clinical interest around LDNs, as their frequency often correlates with disease severity and/or responsiveness to treatment in many pathologies, including cancer , sepsis , HIV‐1 , and mycobacterial infection and autoimmune disorders .…”

“… have shown that CD16 dim CD62L bright band cells are unable to affect T cell proliferation, while, in another report, CD14 − CD24 + immature neutrophils (likely band cells), isolated from the peripheral blood of septic patients, manifested killing properties toward T cells . In view of the diagnostic and prognostic value that has been recently attributed to the mobilization of immature neutrophils as indicator of disease severity and mortality in sepsis and related inflammatory conditions , studies aimed at better elucidating which are the immunoregulatory properties of immature neutrophils, properly separated to a high degree of purity, are required.…”

Measurement of Immature Granulocytes (IG) Percentage to Assess Severe Bacterial Infection in Latvian Children: A Secondary Data Analysis

“…New generation analysers can now provide automated, very precisely enumerated actual IG count and percentage in peripheral blood samples [8][9][10]. Several recent studies have investigated the role of IG percentage measurement as a potential marker to predict severity of an infection [11][12][13][14]. However, these studies were mainly focused on critically ill adult patients at intensive care units.…”