title: Extended leukocyte differential count and C-reactive protein in septic patients with liver impairment: diagnostic approach to evaluate sepsis in intensive care unit.
abstract: BACKGROUND
  Sepsis is still a major cause of death in intensive care units (ICUs) worldwide. Patients with liver impairment express an imbalanced cytokine response which alters common sepsis biphasic nature. Cytokines measurement is expensive, often unavailable, whereas leukocytes (WBC) evaluation performed through hematology analyzers can provide a practical strategy for monitoring inflammatory response.
  
  
  METHODS
  A total of 200 healthy subjects (HS) and 84 patients (18 with, 66 without liver impairment) admitted to ICU, were assessed for International Sepsis Definitions, Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scores. We tested 1,022 peripheral blood samples using Sysmex XN-9000, estimating diagnostic accuracy of leukocyte differential count and nontraditional parameters through receiver operating characteristics (ROC) curves analysis compared to clinical classification.
  
  
  RESULTS
  Median value of all-leukocyte parameters was different in ICU patients compared to HS. Leukocytes, neutrophils (NE) and immature granulocytes (IGs) in sepsis and septic shock (SS) were higher than no sepsis (NS), with an area under the curve: 0.81, 0.82 and 0.78 respectively. Lymphocytes (LY) and monocytes (MO) were significantly associated with liver impairment.
  
  
  CONCLUSIONS
  Diagnostic accuracy of all-leukocyte parameters may provide valuable information for diagnosis and follow-up of sepsis in ICU patients, especially those with liver impairment.
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Buoro
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mecca
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Azzarà
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Apassiti Esposito
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Seghezzi
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Vavassori
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Crippa
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Gianmariano
authors.initials: G
authors.lastname: Marchesi
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Castellucci
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Ottomano
authors.affiliation: 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
keywords: C-reactive protein (CRP); differential leukocyte count; liver disease; sepsis