Thomas Daix1, Estelle Guerin2, Elsa Tavernier3, Emmanuelle Mercier4, Valérie Gissot3, Olivier Hérault5, Jean-Paul Mira6, Florence Dumas7, Nicolas Chapuis8, Christophe Guitton9, Marie C Béné10, Jean-Pierre Quenot11, Cindy Tissier12, Julien Guy13, Gaël Piton14, Anne Roggy15, Grégoire Muller16, Éric Legac17, Nicolas de Prost18, Mehdi Khellaf19, Orianne Wagner-Ballon20, Rémi Coudroy21, Elodie Dindinaud22, Fabrice Uhel23, Mikaël Roussel24, Thomas Lafon25, Robin Jeannet26, Frédéric Vargas27, Catherine Fleureau28, Mickaël Roux29, Kaoutar Allou30, Philippe Vignon31, Jean Feuillard2, Bruno François32. 1. Réanimation Polyvalente, CHU Dupuytren, Limoges, France; Inserm CIC1435, CHU Dupuytren, Limoges, France. 2. Hématologie Biologique, CHU Dupuytren, Limoges, France; CNRS UMR 7276, Université de Limoges, Limoges, France. 3. Inserm CIC1415, CHRU and Université François Rabelais, Tours, France. 4. Réanimation Polyvalente, CHRU de Tours, Tours, France. 5. Hématologie Biologique, CHRU de Tours, Tours, France. 6. Réanimation Médicale Polyvalente, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France. 7. Urgences, Hôpital Cochin/Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris and Inserm UMR 970, Université Paris Descartes, Paris, France. 8. Hématologie Biologique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France. 9. Réanimation Médicale and Inserm UMR1064, CHU de Nantes, Nantes, France. 10. Hématologie Biologique, CHU de Nantes, Nantes, France. 11. Réanimation Polyvalente, CHU François Mitterrand and Lipness Team, Centre de Recherche Inserm LNC-UMR1231 and LabExLipSTIC and Inserm CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon, France. 12. Urgences, CHU de Dijon, Dijon, France. 13. Hématologie Biologique, CHU de Dijon, Dijon, France. 14. Réanimation Médicale, CHRU de Besançon, Université de Franche Comte, UFR SMP, EA3920, Besançon, France. 15. Inserm UMR1098 and Laboratoire d'Immunologie, EFS BFC, Besançon, France. 16. Réanimation Médicale, CHR d'Orléans, Orléans, France. 17. Hématologie Biologique, CHR d'Orléans, Orléans, France. 18. Réanimation Médicale, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, DHU A-TVB, and Université Paris Est Créteil, Faculté de Médecine de Créteil, Groupe de Recherche CARMAS, Créteil, France. 19. Urgences, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France. 20. Hématologie et Immunologie Biologiques, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor and Université Paris-Est Créteil, Inserm UMR 955, Créteil, France. 21. Réanimation Médicale, CHU de Poitiers, Poitiers, France. 22. Hématologie Biologique, CHU de Poitiers, Poitiers, France. 23. Réanimation Médicale and Inserm CIC1414, CHU de Rennes, and Inserm UMR 917, Université de Rennes, Rennes, France. 24. Hématologie Biologique and Inserm UMR 1236, CHU Pontchaillou, Rennes, France. 25. Inserm CIC1435, CHU Dupuytren, Limoges, France; Urgences, CHU Dupuytren, Limoges, France. 26. Hématologie Biologique, CHU Dupuytren, Limoges, France. 27. Réanimation, CHU de Bordeaux, Bordeaux, France. 28. Anesthésie - Réanimation II, CHU de Bordeaux, Pessac, France. 29. Urgences, CHU de Bordeaux, Bordeaux, France. 30. Hématologie Biologique, CHU de Bordeaux, Bordeaux, France. 31. Réanimation Polyvalente, CHU Dupuytren, Limoges, France; Inserm CIC1435, CHU Dupuytren, Limoges, France; Inserm UMR 1092, Université de Limoges, Limoges, France. 32. Réanimation Polyvalente, CHU Dupuytren, Limoges, France; Inserm CIC1435, CHU Dupuytren, Limoges, France; Inserm UMR 1092, Université de Limoges, Limoges, France. Electronic address: b.francois@unilim.fr.
Abstract
BACKGROUND: In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in patients with sepsis admitted in the ED and ICU. METHODS: Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (day 7) and late (day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IGs), and T and B lymphocytes were assessed by flow cytometry using an identical, cross-validated, robust, and simple consensus standardized protocol in each center. RESULTS: Among 1,062 patients screened, 781 patients with confirmed sepsis were studied (age, 67 ± 48 years; Simplified Acute Physiology Score II, 36 ± 17; Sequential Organ Failure Assessment, 5 ± 4). Patients were divided into three groups (sepsis, severe sepsis, and septic shock) on day 0 and on day 2. On day 0, patients with sepsis exhibited increased levels of CD64pos granulocytes, CD16pos monocytes, and IGs with T-cell lymphopenia. Clinical severity was associated with higher percentages of IGs and deeper T-cell lymphopenia. IG percentages tended to be higher in patients whose clinical status worsened on day 2 (35.1 ± 35.6 vs 43.5 ± 35.2, P = .07). Increased IG percentages were also related to occurrence of new organ failures on day 2. Increased IG percentages, especially when associated with T-cell lymphopenia, were independently associated with early (P < .01) and late (P < .01) death. CONCLUSIONS: Increased circulating IGs at the acute phase of sepsis are linked to clinical worsening, especially when associated with T-cell lymphopenia. Early flow cytometry could help clinicians to target patients at high risk of clinical deterioration. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01995448; URL: www.clinicaltrials.gov.
BACKGROUND: In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in patients with sepsis admitted in the ED and ICU. METHODS:Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (day 7) and late (day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IGs), and T and B lymphocytes were assessed by flow cytometry using an identical, cross-validated, robust, and simple consensus standardized protocol in each center. RESULTS: Among 1,062 patients screened, 781 patients with confirmed sepsis were studied (age, 67 ± 48 years; Simplified Acute Physiology Score II, 36 ± 17; Sequential Organ Failure Assessment, 5 ± 4). Patients were divided into three groups (sepsis, severe sepsis, and septic shock) on day 0 and on day 2. On day 0, patients with sepsis exhibited increased levels of CD64pos granulocytes, CD16pos monocytes, and IGs with T-cell lymphopenia. Clinical severity was associated with higher percentages of IGs and deeper T-cell lymphopenia. IG percentages tended to be higher in patients whose clinical status worsened on day 2 (35.1 ± 35.6 vs 43.5 ± 35.2, P = .07). Increased IG percentages were also related to occurrence of new organ failures on day 2. Increased IG percentages, especially when associated with T-cell lymphopenia, were independently associated with early (P < .01) and late (P < .01) death. CONCLUSIONS: Increased circulating IGs at the acute phase of sepsis are linked to clinical worsening, especially when associated with T-cell lymphopenia. Early flow cytometry could help clinicians to target patients at high risk of clinical deterioration. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01995448; URL: www.clinicaltrials.gov.
Authors: Alberto García-Salido; A Martínez de Azagra-Garde; M A García-Teresa; G De Lama Caro-Patón; M Iglesias-Bouzas; M Nieto-Moro; I Leoz-Gordillo; C Niño-Taravilla; M Sierra-Colomina; G J Melen; M Ramírez-Orellana; A Serrano-González Journal: Eur J Clin Microbiol Infect Dis Date: 2019-02-02 Impact factor: 3.267
Authors: Manu Shankar-Hari; Deepankar Datta; Julie Wilson; Valentina Assi; Jacqueline Stephen; Christopher J Weir; Jillian Rennie; Jean Antonelli; Anthony Bateman; Jennifer M Felton; Noel Warner; Kevin Judge; Jim Keenan; Alice Wang; Tony Burpee; Alun K Brown; Sion M Lewis; Tracey Mare; Alistair I Roy; John Wright; Gillian Hulme; Ian Dimmick; Alasdair Gray; Adriano G Rossi; A John Simpson; Andrew Conway Morris; Timothy S Walsh Journal: Intensive Care Med Date: 2018-10-05 Impact factor: 17.440
Authors: M Martin-Fernandez; L M Vaquero-Roncero; R Almansa; E Gómez-Sánchez; S Martín; E Tamayo; M C Esteban-Velasco; P Ruiz-Granado; M Aragón; D Calvo; J Rico-Feijoo; A Ortega; E Gómez-Pesquera; M Lorenzo-López; J López; C Doncel; C González-Sanchez; D Álvarez; E Zarca; A Ríos-Llorente; A Diaz-Alvarez; E Sanchez-Barrado; D Andaluz-Ojeda; J M Calvo-Vecino; L Muñoz-Bellvís; J I Gomez-Herreras; C Abad-Molina; J F Bermejo-Martin; C Aldecoa; M Heredia-Rodríguez Journal: BJS Open Date: 2020-02-19
Authors: Anke Liepelt; Philipp Hohlstein; Hendrik Gussen; Jia Xue; Anna C Aschenbrenner; Thomas Ulas; Lukas Buendgens; Klaudia T Warzecha; Matthias Bartneck; Tom Luedde; Christian Trautwein; Joachim L Schultze; Alexander Koch; Frank Tacke Journal: J Clin Med Date: 2020-01-02 Impact factor: 4.241