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Observational Study
. 2018 Sep;154(3):617-627.
doi: 10.1016/j.chest.2018.03.058. Epub 2018 Apr 26.

Multicentric Standardized Flow Cytometry Routine Assessment of Patients With Sepsis to Predict Clinical Worsening

Thomas Daix  1 , Estelle Guerin  2 , Elsa Tavernier  3 , Emmanuelle Mercier  4 , Valérie Gissot  3 , Olivier Hérault  5 , Jean-Paul Mira  6 , Florence Dumas  7 , Nicolas Chapuis  8 , Christophe Guitton  9 , Marie C Béné  10 , Jean-Pierre Quenot  11 , Cindy Tissier  12 , Julien Guy  13 , Gaël Piton  14 , Anne Roggy  15 , Grégoire Muller  16 , Éric Legac  17 , Nicolas de Prost  18 , Mehdi Khellaf  19 , Orianne Wagner-Ballon  20 , Rémi Coudroy  21 , Elodie Dindinaud  22 , Fabrice Uhel  23 , Mikaël Roussel  24 , Thomas Lafon  25 , Robin Jeannet  26 , Frédéric Vargas  27 , Catherine Fleureau  28 , Mickaël Roux  29 , Kaoutar Allou  30 , Philippe Vignon  31 , Jean Feuillard  2 , Bruno François  32 ; Septiflux Trial Group
Collaborators, Affiliations
Free article
Observational Study

Multicentric Standardized Flow Cytometry Routine Assessment of Patients With Sepsis to Predict Clinical Worsening

Thomas Daix et al. Chest. 2018 Sep.
Free article

Abstract

Background: In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in patients with sepsis admitted in the ED and ICU.

Methods: Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (day 7) and late (day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IGs), and T and B lymphocytes were assessed by flow cytometry using an identical, cross-validated, robust, and simple consensus standardized protocol in each center.

Results: Among 1,062 patients screened, 781 patients with confirmed sepsis were studied (age, 67 ± 48 years; Simplified Acute Physiology Score II, 36 ± 17; Sequential Organ Failure Assessment, 5 ± 4). Patients were divided into three groups (sepsis, severe sepsis, and septic shock) on day 0 and on day 2. On day 0, patients with sepsis exhibited increased levels of CD64pos granulocytes, CD16pos monocytes, and IGs with T-cell lymphopenia. Clinical severity was associated with higher percentages of IGs and deeper T-cell lymphopenia. IG percentages tended to be higher in patients whose clinical status worsened on day 2 (35.1 ± 35.6 vs 43.5 ± 35.2, P = .07). Increased IG percentages were also related to occurrence of new organ failures on day 2. Increased IG percentages, especially when associated with T-cell lymphopenia, were independently associated with early (P < .01) and late (P < .01) death.

Conclusions: Increased circulating IGs at the acute phase of sepsis are linked to clinical worsening, especially when associated with T-cell lymphopenia. Early flow cytometry could help clinicians to target patients at high risk of clinical deterioration.

Trial registry: ClinicalTrials.gov; No.: NCT01995448; URL: www.clinicaltrials.gov.

Keywords: flow cytometry; immunosuppression; inflammation; prognosis; sepsis.

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