title: Measurement of granulocyte maturation may improve the early diagnosis of the septic state.
abstract: BACKGROUND
  Sepsis is a costly diagnosis in hospitalized patients. Failure to diagnose sepsis in a timely manner creates a potential financial and safety hazard. The use of transthyretin, C-reactive protein and procalcitonin measurement as early markers of systemic inflammatory response syndrome (SIRS) and sepsis in association with admission of emergency department patients to the intensive care unit (ICU) has been studied. In these studies the SIRS criteria as well as the use of an elevated neutrophil count with granulocyte precursors (left shift) have proved to be problematic. Despite the validity of procalcitonin measurement (PCT, Brahms) in the early diagnosis of SIRS the cost and time for testing are limiting considerations. Immature granulocyte (IG) measurement has been proposed as a more readily available indicator of the presence of granulocyte precursors (left shift).
  
  
  METHODS
  This study calibrates and validates the measurement of granulocyte maturation [Immature granulocytes (IG)] to the identification of sepsis, a study carried out on a Sysmex Analyzer, model XE 2100 (Kobe, Japan). The Sysmex IG parameter is a crucial measure of immature granulocyte counts and includes metamyelocytes and myelocytes, but not band neutrophils.
  
  
  CONCLUSIONS
  We found agreement with previous work that designated an IG measurement cut-off of 3.2 as optimal. The analysis was then carried a step further with a multivariable discriminator.
authors.affiliation: Triplex Consulting, Trumbull and Norwalk Hospital, Department of Pathology, Norwalk, CT, USA. plbern@yahoo.com
authors.forename: Larry H
authors.initials: LH
authors.lastname: Bernstein
authors.forename: James
authors.initials: J
authors.lastname: Rucinski
mesh_terms: D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D005260:Female; D005434:Flow Cytometry; D006098:Granulocytes / Q000166:cytology* / Q000378:metabolism; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011228:Prealbumin / Q000032:analysis; D011498:Protein Precursors / Q000032:analysis; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*
chemical_list: C000606589:CALCA protein, human; D011228:Prealbumin; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide