Morphological changes in white blood cells in systemic inflammatory response syndrome (SIRS) with and without sepsis: An observational study
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This is an observational study which aims to research morphological changes of white blood cells in patients with Systemic Inflammatory Response Syndrome (SIRS) with and without sepsis and evaluate morphological changes in white blood cells as predictors of sepsis.Patients aged 18 years or more with SIRS with sepsis and SIRS without sepsis were included and those with haematological disorders or pregnant patients were excluded. A total of 52 patients with SIRS with sepsis and 32 patients of SIRS without sepsis were included. Peripheral blood smear was prepared from the venous blood sample drawn. The presence of toxic granules, cytoplasmic vacuoles, and Dohle bodies in both cases of SIRS with sepsis without sepsis were assessed and it was compared with culture-positive sepsis and shock.The difference in the presence of toxic granules (55.8% vs. 12.5%; p <0.001), cytoplasmic vacuoles (30.8% vs. 6.3%; p -0.012), and Dohle bodies (17.3% vs. 0%; p = 0.012) was significantly higher in the SIRS with sepsis group, compared to the SIRS without sepsis group. In the subgroup analysis of patients in the sepsis group, it was observed that patients with positive blood culture (9%) had a significantly higher proportion of toxic granules (100% vs. 51.1%; p=0.059), cytoplasmic vacuoles (40% vs. 29.8%; p=0.637) and Dohle bodies (40% vs. 14.9%; p=0.202). However, these differences were not statistically significant.Toxic granules and cytoplasmic vacuoles in the neutrophils of patients with SIRS with sepsis were found more frequently, compared to patients of SIRS without sepsis. Dohle bodies were found only in patients with sepsis and not in those with SIRS without sepsis.Keywords:
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Abstract Objective To study the value of serum soluble CD14 subtype (sCD14-ST) in early diagnosis of sepsis. Methods Seventy-two patients were diagnosed with systemic inflammatory response syndrome, sepsis, or septic shock. Peripheral blood was collected at 0, 12, 24, and 48 hours after admission to the hospital. Levels of sCD14-ST, procalcitonin (PCT), hypersensitive C-reactive protein (CRP), and white blood cells (WBC) were determined. Results Levels of sCD14-ST in the patients with septic shock were higher than those in the other patients (P < .01) and peaked at 48 h. PCT and CRP levels were similar in the patients at admission but increased by 5 times to 10 times in the next 48 h, especially in the patients with septic shock. WBC levels remained high and did not change dramatically. Receiver operating characteristic analysis revealed that the area under the curve, sensitivity, and specificity values of sCD14-ST to diagnose sepsis were much higher than those of the other markers. Conclusion Compared with PCT, CRP, and WBC, sCD14-ST is a better biomarker for the early diagnosis of sepsis.
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To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis.We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N%), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis.The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT (P < 0.05) but not in CRP (P>0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT (r=0.186, P=0.000), N% (r=0.047, P=0.035) and PLT (r=-0.012, P=0.003) were significantly correlated with the severity of sepsis in these patients.PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.
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Objective
To explore the clinical value of procalcitonin(PCT) in the disease severity and prognosis of patients with sepsis, and the relationship between PCT and acute physiology and chronic health evaluation Ⅱscore (APACHEⅡscore).
Methods
Clinical data(including the value of PCT, the count of the white blood cell WBC and the percent of neutrophils percentage Neut%, APACHEⅡ score, et al, within 24 hours after admission)of 109 sepsis patients admitted to the emergency department (including the general ward and emergency intensive care unit EICU) and infections department of our hospital from January 1st 2013 to December 31st 2014 were retrospectively analyzed. The patients were divided into several groups according to the patients condition(the sepsis group, the severe sepsis group and the septic shock group), the clinical outcomes(the survival group and the dead group), and multiple organ dysfunction syndrome MODS(the MODS group and the non-MODS group), comparing the differences of all markers in each group; to analyze the correlation between PCT and APACHEⅡ score; to assess the value of PCT, APACHEⅡ score and APACHEⅡ score+ PCT for prognosis and multiple organ dysfunction syndrome of patients with sepsis; to have a understanding of the independent effect of PCT on the prognosis andthe factors of prognosis in patients with sepsis.
Results
The value of PCT, APACHEⅡ score in sepsis group was lower than the severe sepsis group and the septic shock group, also the severe sepsis was lower than the septic shock group, and each group was significantly different(P<0.05). Compared with the septic shock group, the count of WBC of sepsis group was significantly lower(P<0.05). Also the dead group compared with the survival group, the APACHEⅡ score was significantly increased(P<0.01), but the values of PCT, WBC, Neut% were not significantly different. The values of APACHEⅡ score, WBC, Neut%, PCT in the non-MDOS group were significantly lower than those in the MODS group(all P<0.05). The relationship between the values of PCT and APACHEⅡ score was significantly correlated(rs=0.403, P<0.01). Using the receiver operating characteristic curve(ROC) for evaluating the prognosis, the area under curve (AUC) of PCT, APACHEⅡ score and the PCT+ APACHEⅡ score respectively were 0.617, 0.899, 0.917, and the last two were significantly better(all P<0.01), also the cut-off, sensitivity and specificity of PCT, APACHEⅡ score were respectively(3.40 ng/mL, 88.24%, 38.04%), (20 scores, 94.12%, 81.52%). As the same to evaluating MODS, the AUC of PCT, APACHEⅡ score and APACHEⅡ score+ PCT respectively were 0.824, 0.796, 0.871, the assessed value between PCT and APACHEⅡ score, between PCT and APACHEⅡ score+ PCT were not significantly different; also the cut-off, sensitivity and specificity of PCT, APACHEⅡ score respectively were(7.26 ng/mL, 88.24%, 63.79%) , (17 scores, 64.71%, 87.93%). The COR and AOR of PCT for the prognosis were respectively 1.008, 1.014, and gender and APACHEⅡ score were the two independent risk factors for the prognosis in patients with sepsis.
Conclusions
The value of PCT and APACHEⅡ score could evaluate the severity of illness in sepsis patients, and the three were positive correlations. APACHEⅡ score, APACHEⅡ score+ PCT had a significantly higher prognostic value than PCT, and PCT could not be a independent marker. But for assessing the MODS in patients with sepsis, the assessed value of PCT, APACHEⅡ score, APACHEⅡ score+ PCT were medium. Gender and APACHEⅡ score were the two independent risk factors for the prognosis in patients with sepsis.
Key words:
Sepsis; Procalcitonin; Acute physiology and chronic health evaluation Ⅱ score; Severity of illness; Prognosis
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Objective To investigate the early diagnostic value and prognostic significance of serum procalcitonin (PCT) in patients with sepsis. Methods Ninety cases between December 2008 and April 2009 were collected. According to the 1991 ACCP/SCCM and 2001 SCCM/ESICM/ACCP/ATS/SIS sepsis diagnosis criteria,they were divided into sepsis group (50 cases), nonbacterial systemic inflammation syndrome group (SIRS group, 17 cases) and control group (23 cases). Sepsis group was divided into two subgroups (survival group and death group) according to 28-day prognosis Dynamic changes of serum PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and neutrophil count percentage (N) on the 1st, 4th day after admission was monitored,meanwhile, the maximal body temperature was recorded. Results The serum PCT level of sepsis group on the 1st day was higher than that in SIRS group and control group,and the difference was statistically significant [6.68 μg/L(1.16-12.46 μg/L) vs 0.22 μg/L(0.05-0.54 μg/L) vs 0.05 μg/L(0.05-0.27 μg/L), P < 0.05]. The serum PCT level of death group was higher than that in survival group,and the difference was statistically significant[11.89μg/L (10.00-28.67 μg/L) vs 2.44 μg/L(1.11-10.00 μg/L),P<0.05]. In sepsis group,serum PCT was positively correlated with APACHE Ⅱ score(r = 0.511, P = 0.000). The area under the ROC curve of PCT was bigger than that of CRP,WBC,N and ESR. The serum PCT level of survival group gradually decreased to normal level after the therapy,but the serum PCT level of death group didn't decrease significantly. Conclusions Serum PCT is a better biomarker in the early diagnosis of sepsis,and its sensitivity and specificity is superior to other inflammation parameters. It positively correlates with the severity of sepsis and can predict the prognosis.
Key words:
Sepsis; C-reactive protein; Prognosis; Procalcitonin
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This is an observational study which aims to research morphological changes of white blood cells in patients with Systemic Inflammatory Response Syndrome (SIRS) with and without sepsis and evaluate morphological changes in white blood cells as predictors of sepsis.Patients aged 18 years or more with SIRS with sepsis and SIRS without sepsis were included and those with haematological disorders or pregnant patients were excluded. A total of 52 patients with SIRS with sepsis and 32 patients of SIRS without sepsis were included. Peripheral blood smear was prepared from the venous blood sample drawn. The presence of toxic granules, cytoplasmic vacuoles, and Dohle bodies in both cases of SIRS with sepsis without sepsis were assessed and it was compared with culture-positive sepsis and shock.The difference in the presence of toxic granules (55.8% vs. 12.5%; p <0.001), cytoplasmic vacuoles (30.8% vs. 6.3%; p -0.012), and Dohle bodies (17.3% vs. 0%; p = 0.012) was significantly higher in the SIRS with sepsis group, compared to the SIRS without sepsis group. In the subgroup analysis of patients in the sepsis group, it was observed that patients with positive blood culture (9%) had a significantly higher proportion of toxic granules (100% vs. 51.1%; p=0.059), cytoplasmic vacuoles (40% vs. 29.8%; p=0.637) and Dohle bodies (40% vs. 14.9%; p=0.202). However, these differences were not statistically significant.Toxic granules and cytoplasmic vacuoles in the neutrophils of patients with SIRS with sepsis were found more frequently, compared to patients of SIRS without sepsis. Dohle bodies were found only in patients with sepsis and not in those with SIRS without sepsis.
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Background and objective To evaluate plasma levels of soluble TREM-1 (sTREM-1) in patients with systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock and to determine whether plasma sTREM-1 could be used as a diagnostic and prognostic marker in sepsis in the surgical ICU. Methods The study was designed as an observational noninterventional clinical study in a surgical ICU of a university hospital. For this, 65 intensive care patients were enrolled within the first 24 h after onset of SIRS (n = 11), severe sepsis (n = 39) or septic shock (n = 15). In addition, 21 healthy volunteers served as controls. At days 0, 1, and 3 after diagnosis, plasma sTREM-1 was measured by ELISA. Results Plasma sTREM-1 concentrations in healthy controls did not significantly differ from those in patients with SIRS, severe sepsis, or septic shock at days 0, 1, and 3. Survivors were defined as septic patients surviving for at least 28 days. There were no differences in plasma sTREM-1 levels between survivors (n = 22) and nonsurvivors (n = 27) on any day. Conclusions In this study in patients with SIRS, severe sepsis, or septic shock, plasma sTREM-1 levels were not elevated as compared with healthy controls. Measurement of plasma sTREM-1 did not distinguish between patients with SIRS, severe sepsis, or septic shock or between survivors and nonsurvivors. The suggested role of sTREM-1 as a diagnostic and prognostic marker in sepsis should be carefully verified.
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Objective
The aim of the study was to investigate the level and diagnostic significance of interleukin (IL)-35 in acute abdominal conditions.
Methods
Plasma specimens were obtained from 50 patients with abdominal sepsis, patients with systemic inflammatory response syndrome (SIRS) and healthy persons, respectively. Plasma IL-35, procalcitonin (PCT), C-reactive protein (CRP), white blood cells (WBC) were measured. The receiver operating characteristic (ROC) curve was used to compare the diagnostic values of IL-35, PCT, CRP and WBC. In addition, the correlation of plasma IL-35 and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in sepsis group was assessed by Spearman correlation analysis.
Results
The plasma level of IL-35 in the sepsis group was significantly higher than the SIRS group and healthy group (both P=0.000). The plasma level of IL-35 in the death group was markedly higher than the survival group. The ROC for the diagnosis of sepsis versus SIRS showed that the AUC of IL-35 (0.86) was greater than that of PCT (0.78), CRP (0.75) and WBC (0.70). Additionally, in the sepsis group, the plasma IL-35 level was positively correlated with APACHEⅡ score (r=0.500, P=0.043).
Conclusion
Plasma level of IL-35 might be a significantly sensitive and useful indicator for rapid diagnosis of abdominal sepsis.
Key words:
Abdominal sepsis; Interleukin-35; Receiver operating characteristic cure
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