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Formenti P, Isidori L, Pastori S, Roccaforte V, Mantovani EA, Iezzi M, Menozzi A, Panella R, Galimberti A, Brenna G, Umbrello M, Pezzi A, Vetrone F, Sabbatini G, Gotti M. A Secondary Retrospective Analysis of the Predictive Value of Neutrophil-Reactive Intensity (NEUT-RI) in Septic and Non-Septic Patients in Intensive Care. Diagnostics (Basel) 2024; 14:821. [PMID: 38667467 PMCID: PMC11049356 DOI: 10.3390/diagnostics14080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Effective identification and management in the early stages of sepsis are critical for achieving positive outcomes. In this context, neutrophil-reactive intensity (NEUT-RI) emerges as a promising and easily interpretable parameter. This study aimed to assess the predictive value of NEUT-RI in diagnosing sepsis and to evaluate its prognostic significance in distinguishing 28-day mortality outcomes. MATERIALS This study is a secondary, retrospective, observational analysis. Clinical data upon ICU admission were collected. We enrolled septic patients and a control group of critically ill patients without sepsis criteria. The patients were divided into subgroups based on renal function for biomarker evaluation with 28-day outcomes reported for septic and non-septic patients. RESULTS A total of 200 patients were included in this study. A significant difference between the "septic" and "non-septic" groups was detected in the NEUT-RI plasma concentration (53.80 [49.65-59.05] vs. 48.00 [46.00-49.90] FI, p < 0.001, respectively). NEUT-RI and procalcitonin (PCT) distinguished between not complicated sepsis and septic shock (PCT 1.71 [0.42-12.09] vs. 32.59 [8.83-100.00], <0.001 and NEUT-RI 51.50 [47.80-56.30] vs. 56.20 [52.30-61.92], p = 0.005). NEUT-RI, PCT, and CRP values were significantly different in patients with "renal failure". NEUT-RI and PCT at admission in the ICU in the septic group were higher in patients who died (58.80 [53.85-73.10] vs. 53.05 [48.90-57.22], p = 0.005 and 39.56 [17.39-83.72] vs. 3.22 [0.59-32.32], p = 0.002, respectively). Both NEUT-RI and PCT showed a high negative predictive value and low positive predictive value. CONCLUSIONS The inflammatory biomarkers assessed in this study offer valuable support in the early diagnosis of sepsis and could have a possible role in anticipating the outcome. NEUT-RI elevation appears particularly promising for early sepsis detection and severity discrimination upon admission.
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Affiliation(s)
- Paolo Formenti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Letizia Isidori
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Stefano Pastori
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Vincenzo Roccaforte
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Elena Alessandra Mantovani
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Massimiliano Iezzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy (A.M.)
| | - Alessandro Menozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy (A.M.)
| | - Rossella Panella
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Andrea Galimberti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Giovanni Brenna
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Michele Umbrello
- Department of Intensive Care, New Hospital of Legnano (Ospedale Nuovo di Legnano), 20025 Legnano, Italy;
| | - Angelo Pezzi
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Francesco Vetrone
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Giovanni Sabbatini
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Miriam Gotti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
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Mantovani EMA, Formenti P, Pastori S, Roccaforte V, Gotti M, Panella R, Galimberti A, Costagliola R, Vetrone F, Umbrello M, Pezzi A, Sabbatini G. The Potential Role of Neutrophil-Reactive Intensity (NEUT-RI) in the Diagnosis of Sepsis in Critically Ill Patients: A Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:1781. [PMID: 37238265 PMCID: PMC10217715 DOI: 10.3390/diagnostics13101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The diagnosis of sepsis is often difficult and belated, substantially increasing mortality in affected patients. Its early identification allows for us to choose the most appropriate therapies in the shortest time, improving patients' outcomes and eventually their survival. Since neutrophil activation is an indicator of an early innate immune response, the aim of the study was to evaluate the role of Neutrophil-Reactive Intensity (NEUT-RI), which is an indicator of their metabolic activity, in the diagnosis of sepsis. Data from 96 patients consecutively admitted to the Intensive Care Unit (ICU) were retrospectively analyzed (46 patients with and 50 without sepsis). Patients with sepsis were further divided between sepsis and septic shock according to the severity of the illness. Patients were subsequently classified according to renal function. For the diagnosis of sepsis, NEUT-RI showed an AUC of >0.80 and a better negative predictive value than Procalcitonin (PCT) and C-reactive protein (CRP) (87.4% vs. 83.9% and 86.6%, p = 0.038). Unlike PCT and CRP, NEUT-RI did not show a significant difference within the "septic" group between patients with normal renal function and those with renal failure (p = 0.739). Similar results were observed among the "non-septic" group (p = 0.182). The increase in NEUT-RI values could be useful in the early ruling-out of sepsis, and it does not appear to be influenced by renal failure. However, NEUT-RI has not proved to be efficient in discriminating the severity of sepsis at the time of admission. Larger, prospective studies are needed to confirm these results.
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Affiliation(s)
- Elena Maria Alessandra Mantovani
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Paolo Formenti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Stefano Pastori
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.); (R.P.)
| | - Vincenzo Roccaforte
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.); (R.P.)
| | - Miriam Gotti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Rossella Panella
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.); (V.R.); (R.P.)
| | - Andrea Galimberti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Roberto Costagliola
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Francesco Vetrone
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Michele Umbrello
- S.C. Anestesia e Rianimazione II, ASST Santi Paolo e Carlo, Ospedale San Carlo, 20148 Milan, Italy;
| | - Angelo Pezzi
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
| | - Giovanni Sabbatini
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (E.M.A.M.); (P.F.); (M.G.); (A.G.); (R.C.); (A.P.)
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Durrieu F. Evaluation of the WBC-differential flagging performances and accuracy of the HORIBA Yumizen H2500 cell counter in oncology patients from a single institution. Int J Lab Hematol 2023; 45:37-45. [PMID: 36351659 DOI: 10.1111/ijlh.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The Yumizen H2500 (YH2500) cell analyser was compared to the Pentra DX Nexus (both from HORIBA Medical) to evaluate the efficiency of the new YH2500 technology for the WBC-differential in samples from oncology patients with WBC-diff abnormalities. MATERIAL AND METHODS The 220 samples with slide review criteria on the Nexus were systematically analysed on the YH2500. The WBC-diff was compared to flow cytometry (FCM). The 100 additional samples with Monocyte/Neutrophil separation flags were evaluated. The flagging performance and the accuracy of the WBC-diff were analysed. RESULTS The YH2500 generated fewer flags than the Nexus (47.73% vs 66.64%; p < .0001), except for Monocyte/Neutrophil flag (15.5% vs. 2.7%; p < 0.0001). Overall performances were higher on the YH2500 (Sensitivity, 100 vs. 89.6%; Specificity 81.0% vs. 50.9%; PPV, 74.3% vs. 62.9%; NPV, 100% vs. 69.5%; Efficiency, 87.7% vs. 69.5%). YH2500 showed a statistically significant better correlation with FCM for the 6-part differential than the Nexus. On 134 samples with Monocyte/Neutrophil separation flag, it was shown that, in samples with less than 10% monocytes on the YH2500, the results of monocyte and neutrophil counts were comparable to the manual count, and that these samples did not need a slide review if no other main criterion for review was present. CONCLUSION The YH2500 demonstrated better performance characteristics than the previous cell counter, the Nexus. Its implementation in our laboratory routine work significantly improved the practice workflow, decreased the number of manual cell counts and increased the pertinence of slide review and reporting of the microscopic count.
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Affiliation(s)
- Françoise Durrieu
- Laboratory of Medical Biology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
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Lee H, Kim HS, Lee JM, Park KH, Choi AR, Yoon JH, Ryu H, Oh EJ. Natural Killer Cell Function Tests by Flowcytometry-Based Cytotoxicity and IFN-γ Production for the Diagnosis of Adult Hemophagocytic Lymphohistiocytosis. Int J Mol Sci 2019; 20:ijms20215413. [PMID: 31671661 PMCID: PMC6862274 DOI: 10.3390/ijms20215413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 01/28/2023] Open
Abstract
Although natural killer (NK) cell function is a hallmark of hemophagocytic lymphohistiocytosis (HLH), there is no standard method or data on its diagnostic value in adults. Thus, we performed a single-center retrospective study of 119 adult patients with suspected HLH. NK cell function was determined using both flowcytometry-based NK-cytotoxicity test (NK-cytotoxicity) and NK cell activity test for interferon-gamma (NKA-IFNγ). NK cell phenotype and serum cytokine levels were also tested. Fifty (42.0%) HLH patients showed significantly reduced NK cell function compared to 69 non-HLH patients by both NK-cytotoxicity and NKA-IFNγ (p < 0.001 and p = 0.020, respectively). Agreement between NK-cytotoxicity and NKA-IFNγ was 88.0% in HLH patients and 58.0% in non-HLH patients. NK-cytotoxicity and NKA-IFNγ assays predicted HLH with sensitivities of 96.0% and 92.0%, respectively. The combination of NKA-IFNγ and ferritin (>10,000 µg/L) was helpful for ruling out HLH, with a specificity of 94.2%. Decreased NK-cytotoxicity was associated with increased soluble IL-2 receptor levels and decreased CD56dim NK cells. Decreased NKA-IFNγ was associated with decreased serum cytokine levels. We suggest that both NK-cytotoxicity and NKA-IFNγ could be used for diagnosis of HLH. Further studies are needed to validate the diagnostic and prognostic value of NK cell function tests.
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Affiliation(s)
- Hyeyoung Lee
- Department of Laboratory Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Korea.
| | - Hoon Seok Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Jong-Mi Lee
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Ki Hyun Park
- Department of Biomedicine & Health Sciences, Graduate School, The Catholic University of Korea, Seoul 06591, Korea.
| | - Ae-Ran Choi
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Hyejin Ryu
- Samkwang Medical Laboratories, Seoul 06742, Korea.
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
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