Use of full blood count parameters and haematology cell ratios in screening for sepsis in South Africa

Abstract

Procalcitonin is a precursor molecule to the thyroid hormone calcitonin and is undetectable in the serum of healthy individuals. Procalcitonin levels correlate with sepsis severity, with serum Background: Sepsis is characterised by multi-organ failure due to an uncontrolled immune response to infection. Sepsis prevalence is increased in developing countries and requires prompt diagnosis and treatment. Reports, although controversial, suggest that full blood count parameters and cell ratios could assist in the early screening for sepsis. Objective:The study evaluated the use of haematological cell ratios in screening for sepsis in a South African population. Methods:The study retrospectively analysed the complete blood counts, blood cultures (BC) and biochemical test results of 125 adult patients who presented between January 2021 and July 2021 at a hospital in Cape Town. An ISO15189-accredited laboratory performed all of the tests. We compared and correlated the automated differential counts, neutrophil, monocyte and platelet-to-lymphocyte ratios with procalcitonin levels. A p-value of < 0.05 was considered significant.Results: Sixty-two sepsis patients (procalcitonin > 2 ng/L and positive BC) were identified and compared to 63 non-sepsis controls. All cell ratios were significantly elevated in sepsis patients (p < 0.001). However, the two groups had no significant difference in absolute monocyte counts (p = 0.377). In addition, no correlation was detected between any cell ratios and procalcitonin. Conclusion:In combination with complete blood count parameters, haematology cell ratios can be used for early sepsis detection. The full blood count is widely available, inexpensive, and routinely requested by emergency care clinicians. Although procalcitonin and BC remain the gold standard, the calculation of cell ratios could provide a simple screening tool for the early detection of sepsis. What this study adds:This study adds evidence to the proposal that calculating haematological cell ratios assists in the early screening of sepsis in a South African setting.

Diagnostic accuracy of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and neutrophil–lymphocyte-to-platelet ratio biomarkers in predicting bacteremia and sepsis in immunosuppressive patients with cancer: literature review

“…Taking a prognostic perspective, Zhang et al 27 (2016) studied NLR according to blood culture test results, excluding patients with hematological malignancies and bone marrow infiltrations, and found high diagnostic efficiency of NLR predicting sepsis. Similarly, Djorjdjevic et al 28 (2018) studied a prospective cohort of 392 critically ill adult and injured patients, observing NLR and PLR with different blood cultures and concluding NLR as an independent predictor of mortality.…”

“…5,6,22 Hematology disorders significantly impact blood studies, but solid tumors may also induce a systemic inflammatory response that may release cytokines and growth factors stimulating neutrophil production in the bone marrow. 7,34,35 Hematological disorders exhibit nondiscriminatory prevalence across diverse conditions. The bone marrow could be affected and disrupted with normal blood cell production in various clinical scenarios, affecting individuals regardless of their health status, age, gender, or other demographic factors.…”