title: Immature/total granulocyte ratio: a promising tool to assess the severity and the outcome of post-cardiac arrest syndrome.
abstract: BACKGROUND
  The immature/total granulocyte (I/T-G) ratio increases during severe systemic inflammatory response syndrome. This study evaluated the I/T-G ratio as a predictor of poor outcome after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  We conducted a pilot prospective cohort study of patients who were admitted in our intensive care unit (ICU) during a one-year period after post-OHCA resuscitation. I/T-G ratio measurements were obtained from blood samples collected on admission using flow cytometry and the outcomes were ICU mortality and post-cardiac arrest syndrome.
  
  
  RESULTS
  Among the 130 patients (76% male, median age 54 [46-67] years), the median I/T-G ratio was 0.85 [0.42-1.98]%. The I/T-G ratio was poorly correlated with the SOFA score and lactate level on day 1 (r=0.25, p=0.005 and r=0.5, p<0.001, respectively). Patients with high I/T-G ratios were more likely to develop post-resuscitation shock (37% vs. 58%, p=0.02). Patients dying from post-resuscitation shock had a higher I/T-G ratio than patients dying from neurological causes (2 [1-4]% vs. 1.2 [0.6-1.2]%, p=0.02). The area under the ROC curve based on the I/T-G ratio was 0.82 for predicting ICU mortality.
  
  
  CONCLUSIONS
  The I/T-G ratio appears to be an accurate predictor of poor outcome. However, the added clinical value of this marker and the possible involvement of immature granulocytes in the pathophysiology of post-cardiac arrest syndrome remain to be investigated.
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France. Electronic address: sauneuf-b@chu-caen.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouffard
authors.affiliation: Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, EA 4652 - MILPAT, équipe MICAH, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Cornet
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Desmeulles
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Masson
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Valette
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Inserm, U 1075 COMETE, F-14032 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.affiliation: Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, EA 4655 U2RM, F-14032 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, F-14033 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, EA 4655 U2RM, F-14032 Caen, France; Faculté de Médecine, Université de Caen Basse-Normandie, F-14032 Caen, France.
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006098:Granulocytes / Q000473:pathology*; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
keywords: Cardiac arrest; Immature granulocytes; Prognosis