title: Use of a weighted, automated analysis of the differential blood count to differentiate sepsis from non-infectious systemic inflammation: the intensive care infection score (ICIS).
abstract: BACKGROUND
  Rapid and accurate diagnosis and immediate treatment of sepsis are of crucial importance. However, differentiating sepsis from Systemic Inflammatory Response Syndrome (SIRS) is a difficult challenge. Many diagnostic approaches based on clinical chemistry surrogate markers have not improved the situation.
  
  
  METHODS
  The ICIS score was established in a cohort of 70 consecutive patients with SIRS. The score includes five parameters involved in the early innate immune response: mature neutrophils count, immature neutrophils count, antibody-secreting cells count, detection of neutrophils and monocytes/macrophages activation. The score can be provided in real-time without sample preparation and is independent from inter-observer variability.
  
  
  RESULTS
  Each ICIS score parameter itself is highly correlated with the occurrence of infection. A mean ICIS value of < 5 (lower cut-off level) indicated the absence of infection whereas the score did not fall below a value of 6 in infected patients throughout the observation time. The area under curve to detect infection for ICIS was found to be highest compared to CRP, LBP, EPO, IL-6 and TNF-α (AUC=0.851, P < 0.0001).
  
  
  CONCLUSIONS
  Cut-off values for ICIS as a marker of infection were defined by this pilot study. The superior discriminative power of ICIS compared to CRP, LBP, EPO, IL-6 and TNF-α is underlined by its high positive and negative predictive value, particularly within the first 48 hours (PPV=79.7%, NPV=74.5%). The ICIS score provides promising potential for reliably and swiftly discriminating sepsis from SIRS in the first critical hours.
authors.affiliation: Department of Medicine, Institute of Immunology, University Witten/ Herdecke, Witten, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Nierhaus
authors.forename: Jo
authors.initials: J
authors.lastname: Linssen
authors.forename: Dominic
authors.initials: D
authors.lastname: Wichmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Braune
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000921:Antibody-Producing Cells; D019540:Area Under Curve; D001772:Blood Cell Count / Q000379:methods*; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008262:Macrophage Activation; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010865:Pilot Projects; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D016207:Cytokines