Search

Background: The pathophysiology of COVID-19 disease is not clearly understood; inflammation has been shown to play a major role. The immature granulocytes count (IGC) can be an indicator of inflammation. To the best of our knowledge, there is no data on the usability of IGC for the diagnosis of COVID-19. Objectives: We aim to investigate the usability of the inflammatory marker IGC in the diagnosis of COVID-19. Patients and Methods: COVID-19 patients admitted to a tertiary university hospital were included in this study, and hemogram parameters, white blood cells, hemoglobin, neutrophils, lymphocytes, and IGC were investigated. According to the real-time reverse transcriptional polymerase chain reaction, patients were categorized into two groups as COVID-19 positive and COVID-19 negative. Results: The mean value of IGC was 0.02 (0.02) for the COVID-19-positive group and 0.11 (0.04) for the COVID-19-negative group. Patients with COVID-19 positive were found to have an IGC value that is significantly lower than the other group (P < 0.001). For IGC, it was calculated at a cut-off value of 0.03 (area under the curve: 0.718; sensitivity: 66.7%; specificity: 72.3%; P < 0.001). Conclusions: The results of our study have shown that on-admission IGC level is a novel, cost-effective, and readily available biomarker with a promising predictive marker for COVID-19 patients.

Objectives Spontaneous intracerebral hemorrhage (ICH) accounts for 10 to 20% of all types of stroke and is associated with high mortality and morbidity rates. Neuroinflammation caused by intracerebral blood includes resident microglia activation, infiltration of systemic immune cells, and production of cytokines, chemokines, extracellular proteases, and reactive oxygen species. Despite several findings demonstrating that an immature granulocyte (IG) count can be a prognostic indicator as an inflammatory parameter in many diseases, no studies conducted on ICH patients are available in the literature. Therefore, in this study, we aimed to investigate the relationship between the 30-day mortality rate and the IG count obtained at the time of admission in ICH patients. Methods Demographic characteristics and laboratory test results of patients, who were diagnosed with ICH and hospitalized accordingly upon arrival at the emergency ward in our tertiary care hospital in the period from January 2019 and December 2019, were recorded. The endpoint of the study was the examination of the relationship between the short-term mortality (within 30 days after hospitalization) and the IG count at admission. Results Seventy patients, who met the inclusion criteria, were included in the study. Of these patients, 40 (57.1%) were males and the mean age was 68.04 ± 13.08 years. Patients with poor prognosis had higher IG counts (p = 0.001). The 30-day mortality rate was 33.3% (11/33) in the high IG count (≥0.6) group and 5.4% (2/37) in the low IG count (< 0.6) group (p = 0.004). In the regression analysis, we found out a significant relationship of the IG count to the 30-day mortality, with an odds ratio of 5.157(95% CI = 0.914–29.087, p = 0.029). Conclusion An IG count can be obtained from a simple full blood count, is easy to apply, does not result in extra costs, and is used as a marker to predict the 30-day prognosis.

Introduction As the Coronavirus disease 2019 (COVID‐19) pandemic is still ongoing with patients overwhelming healthcare facilities, we aimed to investigate the ability of white blood cell count (WBC) and their subsets, high fluorescence lymphocyte cells (HFLC), immature granulocyte count (IG), and C‐reactive protein (CRP) to aid diagnosis of COVID‐19 during the triage process and as indicators of disease progression to serious and critical condition. Methods We collected clinical and laboratory data of patients, suspected COVID‐19 cases, admitted at the emergency department of University General Hospital of Ioannina (Ioannina, Greece). We selected 197 negative and 368 positive cases, confirmed by polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. COVID‐19 cases were classified into mild, serious, and critical disease. Receiver operating characteristic curve and binary logistic regression analysis were utilized for assessing the diagnosing ability of biomarkers. Results WBC, neutrophil count (NEUT), and HFLC can discriminate efficiently negative cases from mild and serious COVID‐19, whereas eosinopenia and basopenia are early indicators of the disease. The combined WBC‐HFLC marker is the best diagnostic marker for both mild (sensitivity: 90.6% and specificity: 64.1%) and serious (sensitivity: 90.3% and specificity: 73.4%) disease. CRP and Lymphocyte count are early indicators of progression to serious disease whereas WBC, NEUT, IG, and neutrophil‐to‐lymphocyte ratio are the best indicators of critical disease. Conclusion Lymphopenia is not useful in screening patients with COVID‐19. HFLC is a good diagnostic marker for mild and serious disease either as a single marker or combined with WBC whereas IG is a good indicator of progression to critical disease.

Aims Early identification of patients at risk of adverse outcomes may increase the survival rates in patients with upper gastrointestinal bleeding (UGIB), but this can be difficult to predict in emergencies. The aim of the study is to evaluate immature granulocyte (IG), which can be obtained from simple hemogram tests in patients with UGIB, in terms of clinical use and as a mortality marker. Materials and methods The patients diagnosed with UGIB between March 1, 2019, and September 30, 2019, were evaluated retrospectively. Demographic characteristics, causes of hemorrhage, clinical presentations, hemogram, and biochemistry values at ED admission and 30-day mortality status of the patients were examined. We divided the patients into groups according to their mortality status, and the groups were compared among themselves in terms of parameters. Results A total of 213 patients who met the inclusion criteria were included in the study. Of these patients, 139 (65.3%) were male and the mean age was 65.05 ± 16.7 years. Fifteen (7%) of them were in the nonsurvival group, while 198 (93%) were in the survival group. The efficacy of both the IG count (IGC) and IG% in predicting mortality was statistically significant (p = 0.002, p = 0.008, respectively). The sensitivity and specificity for the IGC were found as 60% and 84.4; for the IG%, they were found as 66.7% and 75.7%, respectively. Conclusion IGC and IG% are independent risk factors for the 30-day mortality status. These measurements are obtained from simple hemogram tests and may be useful for the evaluation of mortality in patients with UGIB. How to cite this article Bedel C, Korkut M, Avci A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med 2020;24(9):794-798.

Background: The aim of this study was to investigate the usability of immature granulocyte count (IGC), immature granulocyte percentage (IG%), and IGC to neutrophil ratio (IGC/N ratio), a new inflammatory marker, in both diagnosing acute appendicitis (AA) and differentiation of simple and complicated appendicitis (SA and CA). Materials and Methods: This study was conducted on 262 adult patients who underwent appendectomy. The patients were histopathologically divided into positive and negative appendectomy groups. The patients in the AA group were also divided into SA and CA subgroups. The demographic and laboratory data of the patients were compared. Results: The mean values of white blood cell count, neutrophil-to-lymphocyte ratio, IGC, IG%, IGC/N, and C-reactive protein (CRP) are the parameters that can be used both to diagnose AA and to differentiate CA from SA. In our study, the ability of IGC to predict AA was found to be greater than that of other parameters. For IGC, the area under the receiver operating characteristic curve (AUC) was 0.784, the sensitivity was 98.3% and the specificity was 80%. CRP and IGC/N ratio had the highest specificity predictive values in differentiating CA from SA. For IGC/N, the AUC was 0.702, the sensitivity was 63.9%, and the specificity was 72.3%. Conclusion: IGC is a reliable inflammatory marker in the diagnosis of AA but immature granulocytes and derivatives (IGC, IG%, and IGC/N) cannot be used for predicting CA because of low sensitivity and specificity.

Chemotherapy-induced febrile neutropenia (FN) causes life-threatening complications, but little is known in septic shock patients with FN. The aim of this study was to investigate the prognostic value of inflammatory markers, including C-reactive protein level, immature granulocyte count, white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), in septic shock patients with FN at admission and after granulocyte colony-stimulating factor (G-CSF) administration.Data on consecutive adult septic shock patients with FN treated with G-CSF between June 2012 and June 2017 were extracted from a prospectively compiled septic shock registry. Clinical and serial laboratory data at admission and24 h after G-CSF administration were compared between nonsurvivor and 1-month survivor groups.Of 1,671 septic shock patients, 158 FN patients were treated with G-CSF and 114 (72.2%) survived for 1 month. At admission, no clinical and serial laboratory data were significant to predict survival. After G-CSF administration, PLR and APACHE II were independent predictors for 1-month survival. PLR after administration of G-CSF100 (adjusted odds ratio [aOR], 9.394; 95% CI, 2.821-31.285, P0.001) showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 89.4%, 46.2%, 82.9%, and 60.0%, respectively, and APACHE II28 (aOR, 6.944; 95% CI, 2.351-20.511, P 0.001) showed sensitivity, specificity, PPV, and NPV of 86.8%, 63.6%, 86.1%, and 65.1%, respectively.After G-CSF administration in septic shock patients with chemotherapy-induced FN, PLR may be used as an early prognostic marker for mortality.

To evaluate the predictive value of immature granulocytes in intestinal necrosis in incarcerated hernia. The study included patients who were operated on due to incarcerated hernia. The cases were separated into 2 groups as those with or without bowel resection. Age, gender, hernia type, side, white blood cell count, neutrophil count, neutrophil–lymphocyte ratio, red cell distribution width count, immature granulocyte count, platelet count, and platelet lymphocyte ratio were statistically compared between the groups. There were 27 cases (17.3%) in the group with bowel resection and 127 cases (82.7%) in the group without bowel resection. A statistically significant difference was determined between the groups in respect of the hernia type, white blood cell count, neutrophil count, neutrophil–lymphocyte ratio and immature granulocyte count (p 0.065 were found to be independent predictors of necrosis development. The immature granulocyte value is a fast, easily accessible and reliable marker that can be used to predict intestinal necrosis in cases of incarcerated hernia.

INTRODUCTION: This study was designed to compare the immature granulocyte (IG) count, IG-to-lymphocyte ratio (IGLR), complete blood count (CBC) values, and inflammatory parameters of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), ferritin level, and CRP-to-albumin ratio (CAR) measured at hospital admission in patients with coronavirus disease 2019 (COVID-19) and non-COVID-19 patients and to compare these parameters between subgroups according to disease severity. In addition, these parameters were evaluated for predictive value related to the severity of COVID-19. METHODS: The data of adult patients admitted with a suspected COVID-19 infection confirmed with real-time polymerase chain reaction testing of nasal and pharyngeal swab specimens were included in this retrospective study. Outpatient COVID-19-positive patients were enrolled in the mild group, hospitalized patients were classified in the moderate group, and patients admitted to the intensive care unit were categorized in the severe group. RESULTS: A total of 1213 COVID-19-positive patients and 1034 COVID-19-negative patients were included in the study. The IGLR, NLR, PLR, CRP, CAR, and ferritin levels were significantly higher, and the leukocyte, IG, neutrophil, lymphocyte, monocyte, basophil, and eosinophil levels were significantly lower in the COVID-19-positive group than the COVID-19-negative group (p

Although appendectomy is still a curative therapy for acute appendicitis, medical treatment has come to the fore in uncomplicated cases. This study aimed to determine the importance of immature granulocyte (IG) count and percentage for the role of medical treatment success in uncomplicated acute appendicitis.Acute appendicitis cases were prospectively registered between July 2019 and April 2020. Using ball drawing, patients were divided into two groups as medical treatment (Group M) and undergo appendectomy (Group A). Group M was divided into two subgroups as those who responded to medical treatment medically responded (MR) and failed medical treatment (MF) within 24 h of follow-up. Changes in IG count and percentage, C-reactive protein levels, neutrophil-lymphocyte ratio, and white blood cell count between initial administration and 24th h of follow-up were examined.Sixty-four patients who met the inclusion criteria were followed as 31 patients in Group A and 33 in Group M. At Sub-group MF 11 patients and Subgroup MR 22 patients were followed up. At the 24th h of the follow-up, the IG count and percentage were higher in the Group MF (for IG count: Between Group A and MF, p=0.002; between Group A and Group MR, p=0.111; and between Group MR and MF, p0.001) (for IG percentage: Between Group A and MF, p=0.001; between Group A and MR, p=0.809; and between Group MF and MR, p=0.001). This decrease in the IG count and percentage suggests that the response to medical treatment was effective [for IG count: F (148.862) = 61, p≤0.001, η2=0.707] [for IG percentage: F (10.157) = 0.252, p≤0.001, η2=0.504].IG count and percentage are effective for evaluating the success of medical treatment of uncomplicated acute ap-pendicitis and they guide in the decision to continue medical treatment of uncomplicated acute appendicitis.

How to cite this article: Prabu NR, Patil VP. Is Immature Granulocyte Count a Potential Prognostic Marker for Upper Gastrointestinal Tract Bleeding? A New Road to Explore. Indian J Crit Care Med 2020;24(9):750-752.

Objective To evaluate the application value of time to positivity (TTP) for blood culture combined with inflammatory parameters that included immature granulocyte percentage (IG%), immature granulocyte count (IG#), C‐reactive protein (CRP), white blood cells (WBC) neutrophil percentage (NE%), and neutrophil‐to‐lymphocyte ratio (NLR), and to identify bloodstream infections from contamination with coagulase‐negative staphylococci (CoNS) in pediatric patients. Methods Data of 12 897 inpatients with blood culture CoNS were retrospectively collected and analyzed from January‐December 2019 at our hospital. According to pre‐defined criteria, they were divided into a CoNS infection group (132 cases) and a CoNS contamination group (124 cases). Infection with Staphylococcus aureus (SA, 27 cases) at the same period was considered a positive control group. ROC curve analysis assisted in determining the value of applying TTP combined with the above‐mentioned inflammatory parameters to distinguish CoNS infection from contamination. Results Among the 256 strains of CoNS, Staphylococcus hominis (55.1%), Staphylococcus epidermidis (32.0%), and Staphylococcus capitis (7.0%) were common. There was no significant difference in the subspecies distribution between the infection and contamination groups. The TTP of the CoNS infection group was significantly lower than the contamination group (P, ROC analysis of TTP and inflammatory parameters in identifying CoNS bloodstream infection from contamination. A: ROC curve analysis of single indicators including IG%, IG#, CRP, NE%, and NLR. The AUC of TTP was the highest, reaching a value of 0.913, the AUC of IG% was 0.712, and the AUC of IG#, CRP, NE%, and NLR were 0.679, 0.645, 0.595, and 0.605, respectively, which were all evidently lower than 0.7. B: ROC curve analysis of TTP combined with inflammatory parameters. When TTP was combined with IG%, IG#, CRP, or NLR, the AUC was 0.951, 0946, 0.945, and 0.923, respectively. When TTP was combined with IG%, CRP, and NLR, the AUC was the highest, with a value of up to 0.977.

Context.—Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies.Objective.—To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature.Design.—This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile.Results.—The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%.Conclusions.—This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.

Background Equipoise exists regarding sickle cell disease (SCD) as a risk factor for COVID-19 disease severity and variables that increase risk of COVID-19 severity in SCD. Given our health system's large SCD patient catchment, we analyzed our own experience in this regard. Study methods Retrospective analysis of the clinical course and factors associated with need for hospitalization and ICU admission of SCD patients diagnosed with COVID-19 through the Northwell Health system from March 1 to Dec 31, 2020. Results Of 1098 patients with SCD, 3.3% were diagnosed with COVID-19. Overall rates of hospitalization, ICU admission, cohort mortality, and in-hospital mortality were 80%, 19%, 2.5%,and 3.1%, respectively. By multivariable analysis, hospitalization risk was decreased by 60% for every 1 g/dL increase in admission Hb. ICU admission risk was increased by 84% as a health care worker; increased by 45% for every 1000/uL increase in admission immature granulocyte count; and decreased by 17% with hydroxyurea use. Discussion High hospitalization rates are compatible with worsened severity upon COVID-19 infection in SCD compared to the general population. Patients should be placed on hydroxyurea to increase their Hb and perhaps lower their neutrophil counts. Health care workers with SCD may warrant special safety precautions.

INTRODUCTION: The XN-550 is a new, automated, compact, haematology analyser designed to generate a full blood count with a standard five-part white blood cell differential and an immature granulocyte count, as well as an optional reticulocyte and optical platelet (PLT) counts. The aim of the study was to evaluate the performance of the XN-550 and compare it to the established XN-20 system. METHODS: We evaluated the basic parameter and special measurement channels of the XN-550, using the XN-20 (which has a similar operating system), as a reference analyser. Precision, carry-over and throughput evaluations were performed. In addition, a total of 202 samples including normal controls and various pathological samples were studied for comparability. RESULTS: Good correlations with the reference analyser were obtained for all parameters except basophils. The XN-550 offers impedance and optical PLT counts and the latter showed a better correlation and less scatter than the impedance count and was comparable to the XN-20 fluorescent count at PLT counts ≤40×109/L. Precision was good, and no significant carry-over was detected. CONCLUSIONS: The XN-550 was simple and easy to use, while maintaining the good diagnostic sensitivity seen with high-range systems such as the XN-20, making this compact device suitable for near-patient services and smaller satellite laboratories.

Lactate, white blood cell (WBC) and neutrophil count, procalcitonin and immature granulocyte (IG) count were compared for the prediction of sepsis, and severe sepsis or septic shock, in patients presenting to the emergency department (ED).We prospectively enrolled 501 ED patients with a sepsis panel ordered for suspicion of sepsis. WBC, neutrophil, and IG counts were measured on a Sysmex XT-2000i analyzer. Lactate was measured by i-STAT, and procalcitonin by Brahms Kryptor. We classified patients as having sepsis using a simplification of the 1992 consensus conference sepsis definitions. Patients with sepsis were further classified as having severe sepsis or septic shock using established criteria. Univariate receiver operating characteristic (ROC) analysis was performed to determine odds ratio (OR), area under the ROC curve (AUC), and sensitivity/specificity at optimal cut-off for prediction of sepsis (vs. no sepsis), and prediction of severe sepsis or septic shock (vs. no sepsis).There were 267 patients without sepsis; and 234 with sepsis, including 35 patients with severe sepsis or septic shock. Lactate had the highest OR (1.44, 95th% CI 1.20-1.73) for the prediction of sepsis; while WBC, neutrophil count and percent (neutrophil/WBC) had OR1.00 (p0.05). All biomarkers had AUC0.70 and sensitivity and specificity70% at the optimal cut-off. Initial lactate was the best biomarker for predicting severe sepsis or septic shock, with an odds ratio (95th% CI) of 2.70 (2.02-3.61) and AUC 0.89 (0.82-0.96).Traditional biomarkers (lactate, WBC, neutrophil count, procalcitonin, IG) have limited utility in the prediction of sepsis.

Modern hematology laboratories use automated hematology analyzers to perform cell counts. These instruments provide accurate, precise, low-cost differential counts with fast turnaround times. Technologies commonly used include electrical impedance, radiofrequency conductivity, laser light scattering, and cytochemistry. This article reviews the principles of these methodologies and possible sources of error, provides guidance for selecting flagging criteria, and discusses novel, clinically relevant white blood cell parameters provided by new instruments, including immature granulocyte count and granularity index.

Background Autologous peripheral blood hematopoietic stem cell (PBSC) collection efficiency (CE) is reportedly affected by the patient's blood properties; however, studies to identify factors correlated with CE have shown inconsistent results. Additionally, variables such as stem cell graft granulocyte content and patient age, sex, and underlying disease, may be associated with hematopietic stem cell (HSC) infusion-related adverse reactions. In this study, we evaluated the correlation of preleukapheresis PB granulocyte count and PBSC harvest variables with CD34+ collection yield and efficiency, and thawed HSC infusion side effect occurrence. Patients and methods We evaluated data from 361 patients who had undergone autologous PBSC transplant. Large volume leukapheresis was the method for PBSC collection. Complete Blood Count and CD34+ cell enumeration were performed in the preapheresis PB and the apheresis product sample. The PBSC grafts were submitted to non-controlled rate freezing after addition of 5% DMSO plus 6% hidroxyethylstarch as a cryoprotectant solution. The cryopreserved graft was thawed in a 37°C water bath and then infused without further manipulation. Results The CD34+ yield was associated with preapheresis PB CD34+ count and immature granulocyte count. The PBSC CE was negatively correlated with preapheresis white blood cell (WBC), immature granulocyte and granulocyte count. The leukapheresis product total nucleated cell (TNC) and granulocyte content was correlated with the thawed graft infusion side effect occurrence. Conclusion This study has shown that preapheresis PB WBC and granulocyte counts were associated with leukapheresis CE. Additionally, the leukapheresis product TNC and granulocyte content was correlated with thawed graft infusion side effect occurrence.

Recent advances in automation of haematology analysers have significantly shortened turn-around-times for reporting leukocyte differential and count in the peripheral blood. Due to the introduction of improved flagging rates, the amount of microscopic peripheral blood slide reviews can be minimised.1 Having access to an enormous amount of data, one has to find the balance between productivity and clinical quality. Reliable automated blood cell characterisation and quantification remain challenging in pathological samples, whereas slide reviews due to unnecessary flagging should be avoided in normal samples. An important feature of the automated haematology cell counters is their ability to identify and quantify immature granulocytes (IG) in a peripheral blood sample. Recently, the Sysmex XN series was introduced and its performance was evaluated.2 It provides the possibility to automatically count the IG in the peripheral blood. After applying a specific lysing agent (Lysercell WDF), the IG are measured in the WDF channel and differentiation is made based on granularity (side scatter) and nucleic acid content (side fluorescence by the Fluorocell WDF reagent). The IG cluster is found right above the neutrophil cluster in the biparametric histogram side scatter/fluorescence. The IG fraction includes promyelocytes, myelocytes and metamyelocytes (blasts and band cells are not included). In the present study, …

Recently, St. Anthony's Medical Center Laboratory (SAMC) in St. Louis, Missouri, installed a new automated hematology analyzer, the Sysmex XE-2100. The XE-2100 has an additional differential parameter, the immature granulocyte (IG) parameter. Prior to implementation, the IG parameter was evaluated by comparison to the manual immature granulocyte count. Immature granulocytes counted manually, as well as the automated count, included metamyelocytes, myelocytes, and promyelocytes. Manual differentials were performed on each specimen by 2 experienced medical technologists using the National Committee for Clinical Laboratory Standards (NCCLS) document H20-A. In addition to evaluating the IG parameter, St. Anthony's laboratory plans to report the automated IG count from the XE-2100, withor=0.54 IG percentage andor=0.1 x 103 IG number considered to be normal and to redefine its manual review criteria. An IG percentageor=5% and an absolute IG number ofor=0.5 x 103 will require differentiation by a manual differential count. An IG percentage5% and an absolute IG number of0.5 x 103 will not require differentiation by manual slide review. In this comparison of the IG count on the XE-2100 to the manual count, the correlation coefficient was 0.83. The XE-2100 IG results showed significant correlation with the results from the manual immature granulocyte count. We concluded that the XE-2100 IG demonstrated comparable performance to the manual IG count.

Background The post-resuscitation phase after out-of-hospital cardiac arrest (OHCA) is characterised by a systemic inflammatory response (e.g., severe sepsis), for which the immature granulocyte count is a diagnostic marker. In this study we evaluated the prognostic significance of the delta neutrophil index (DNI), which is the difference in leukocyte subfractions as assessed by an automated blood cell analyser, for early mortality after OHCA. Materials and Methods OHCA records from the emergency department cardiac arrest registry were retrospectively analysed. Patients who survived at least 24 h after return of spontaneous circulation were included in the analysis. We evaluated mortality and cerebral performance category scores at 30 days. Results A total of 83 patients with OHCA were included in the study. Our results showed that DNI >8.4% on day 1 (hazard ratio [HR], 3.227; 95% CI, 1.485–6.967; p = 0.001) and DNI >10.5% on day 2 (HR, 3.292; 95% CI, 1.662–6.519; p8.4% on day 1 (HR, 2.718; 95% CI, 1.508–4.899; p10.5% on day 2 (HR, 1.709; 95% CI, 1.051–2.778; p = 0.02) were associated with worse neurologic outcomes 30 days after OHCA. Conclusion A higher DNI is a promising prognostic marker for 30-day mortality and neurologic outcomes after OHCA. Our findings indicate that patients with elevated DNI values after OHCA might be closely monitored so that appropriate treatment strategies can be implemented.

The XE 2100 (Sysmex Corporation) is a cell counter that furthers the technology of fluorescent flow cytometry developed from the earlier range of Sysmex analysers. The new diagnostic features are a nucleated red cell count (NRBC), the ability to measure platelets by impedance as well as an 'optical' platelet count using a fluorescence dye -and an immature granulocyte (IG) count. The NRBC count was highly correlated (r = 0.97) with the manual reference count. For counts below 100 x 10 9 /l the 'optical' method and the immunocount gave good a correlation (r = 0.97) optical and impedance counts were also well correlated (r = 0.89). The use of the 'optical' platelet count significantly improves the reliability of low platelet counts. The IG count correlated with visual counts (r = 0.81) and allows the detection of immature cells at an earlier stage in the laboratory process. The introduction of fluorescent flow cytometric analysis allows extended quantification of additional cell populations and so potentially improves screening and monitoring of various pathological conditions.

© 2013 Cimenti et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Role of Immature Granulocyte Count and Immature Myeloid Information in the Diagnosis of Neonatal Sepsis

The delta neutrophil index corresponds to the calculated immature granulocyte counts and the severity of sepsis. This study investigated the diagnostic value of the delta neutrophil index as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.

The granulocytic “shift to left” reflects marrow response to bacterial infection, and this may be quantified as band count or immature granulocyte count (IGC). The former value, used widely in neonatal sepsis, has been notoriously difficult to measure accurately and precisely. A reproducible, precise, and accurate counting of immature granulocyte counts may be possible with automation. This study of 200 febrile patients aimed at analysing the performance characteristics of automated immature granulocytes (AIGs) in predicting blood culture and their clinical utility. The absolute (IGC) and relative IG count (IG%) had area under curve (AUC) of 0.69 and 0.66. Moreover, the means of IGC and IG% between culture positive and negative groups were statistically significant suggesting that they are potential markers for bacteremia. IGC of 0.03 × 103 cu⋅mm and IG% of 0.5% offered sensitivity of 86.3% and 92.2%, respectively, and may be used for screening for bacteremia. Higher values, IGC > 0.3, and IG% > 3 had specificity greater than 90%, although the values were infrequent. It may not be long before that these automated hemograms are put into regular diagnostic use.

BACKGROUND To determine the predictive value of the immature granulocyte count and the immature myeloid information in neonatal early onset sepsis we examined 133 blood samples of patients admitted to our neonatal intensive care unit. METHODS Measurements were performed using the Sysmex XE-2100, an automated hematological analyzer. Patients were divided into two groups: 1) symptomatic neonates with diagnosis of early onset sepsis; and 2) controls including asymptomatic neonates who were admitted because of prematurity, low birth weight, or delayed postnatal transition. RESULTS The number of immature granulocytes and the immature myeloid information were significantly elevated in neonates with early onset sepsis compared to controls (median 280/μL vs. 50/μL, p=0.049 and 639/μL vs. 89/μL, p

quantified as the band or immature granulocyte (IG) count. The aim of this study was to analyze the IG count performance of the Sysmex XN-9000 hematology analyzer in intensive care unit (ICU) patients.Methods. 480 peripheral blood samples from adult patients admitted to the ICU (301 control, 119 sepsis and 60 septic shock) were analyzed with Sysmex XN-9000. Serum C reactive protein (CRP) was measured on Siemens ADVIA 2400. IG count in peripheral blood was determined either by XN-9000 or optical microscopy (OM). Agreement between the two methods was assessed with Pearson’s correlation, Passing-Bablok regression and Bland Altman bias. Diagnostic accuracy was estimated through ROC curves analysis. Sysmex XN-9000 imprecision and within-run precision were also evaluated.Results. Pearson’s correlation (r) relative to IG count, as absolute and percentage values, was 0.89 (p

Background The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis. Methods One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer. Results Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure. Conclusions DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock.

The properties of a reference bacterial endotoxin prepared from Escherichia coli and its phthalylated derivative were studied in normal human volunteers infected intravenously with the compounds. The minimal pyrogenic dose of the reference endotoxin is about 0.1-0.5 ng/kg. The increase in white blood cell count, absolute granulocyte count, absolute immature granulocyte count, and concentrations of serum amyloid A, cortisol, and growth hormone was directly related to the concentration of reference endotoxin administered. Phthalylated reference endotoxin up to 1,000 ng/kg (at least 500 ng of the patent compound/kg) was administered to normal human volunteers without significant changes in temperature, white blood cell count, absolute granulocyte count, and concentrations of serum amyloid A, cortisol, and growth hormone. Thus, this study defines biologic properties of the new reference bacterial endotoxin in humans and demonstrates effective detoxification by phthalylation of the present compound.