title: The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation.
abstract: BACKGROUND
  In this cohort study, we investigated whether monitoring blood levels of immature neutrophils (myelocytes, metamyelocytes and band cells) differentiated patients with sepsis from those with the non-infectious (N-I) systemic inflammatory response syndrome (SIRS). We also ascertained if the appearance of circulating immature neutrophils was related to adverse outcome.
  
  
  METHODS
  Blood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects. Clinical and laboratory staff were blinded to each other's results, and patients were retrospectively characterised into those with SIRS (n = 122) and those without SIRS (n = 14). The patients with SIRS were further subdivided into categories of definite sepsis (n = 51), possible sepsis (n = 32) and N-I SIRS (n = 39). Two established criteria were used for monitoring immature white blood cells (WBCs): one where band cells >10% WBCs and the other where >10% of all forms of immature neutrophils were included but with a normal WBC count. Immature neutrophils in blood smears were identified according to nuclear morphology and cytoplasmic staining.
  
  
  RESULTS
  With the first criterion, band cells were present in most patients with SIRS (mean = 66%) when compared with no SIRS (mean = 29%; P <0.01) and with healthy subjects (0%). The prevalence of band cells was higher in definite sepsis (mean = 82%) than in patients with possible sepsis (mean = 63%; P <0.05) or with N-I SIRS (mean = 39%; P <0.001), and they had a sensitivity of 84% and a specificity of 71% for the detection of definite sepsis. With the second criterion (that is, patients with normal WBC counts), we noted that immature neutrophils did not differentiate any of the patient groups from one another. Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).
  
  
  CONCLUSIONS
  Raised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. tracey.1.mare@kcl.ac.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. tracey.1.mare@kcl.ac.uk.
authors.forename: Tracey Anne
authors.initials: TA
authors.lastname: Mare
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. david.treacher@gstt.nhs.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. david.treacher@gstt.nhs.uk.
authors.forename: David Floyd
authors.initials: DF
authors.lastname: Treacher
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. manu.shankar-hari@gstt.nhs.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. manu.shankar-hari@gstt.nhs.uk.
authors.forename: Manu
authors.initials: M
authors.lastname: Shankar-Hari
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. richard.beale@gstt.nhs.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. richard.beale@gstt.nhs.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Beale
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. sion.lewis@gstt.nhs.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. sion.lewis@gstt.nhs.uk.|Vascular Immunology Research Laboratory, Rayne Institute (King's College London), St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. sion.lewis@gstt.nhs.uk.
authors.forename: Sion Marc
authors.initials: SM
authors.lastname: Lewis
authors.affiliation: Cardiac Surgical Research, The Rayne Institute (King's College London), Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. david.chambers@kcl.ac.uk.
authors.forename: David John
authors.initials: DJ
authors.lastname: Chambers
authors.affiliation: Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. alun.brown@kcl.ac.uk.|Division of Asthma, Allergy and Lung Biology, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. alun.brown@kcl.ac.uk.|Vascular Immunology Research Laboratory, Rayne Institute (King's College London), St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. alun.brown@kcl.ac.uk.
authors.forename: Kenneth Alun
authors.initials: KA
authors.lastname: Brown
mesh_terms: D000368:Aged; D001800:Blood Specimen Collection; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D002452:Cell Count; D003937:Diagnosis, Differential; D005260:Female; D042381:Granulocyte Precursor Cells / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010976:Platelet Count; D011379:Prognosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality
chemical_list: D002097:C-Reactive Protein