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

Thomas Daix 1, 2 Estelle Guerin 3 Elsa Tavernier 4 Emmanuelle Mercier 5 Valérie Gissot 6 Olivier Herault 5 Jean-Paul Mira 7 Florence Dumas 7, 8 Nicolas Chapuis 7 Christophe Guitton 9, 10 Marie C Béné 11 Jean-Pierre Quenot 12, 13, 14 Cindy Tissier 15 Julien Guy 16 Gaël Piton 17, 18 Anne Roggy 19, 20 Grégoire Muller 21 Éric Legac 22 Nicolas De Prost 23 Mehdi Khellaf 24 Orianne Wagner-Ballon 24, 25 Rémi Coudroy 26 Elodie Dindinaud 26 Fabrice Uhel 27, 28 Mikaël Roussel 28, 29 Thomas Lafon 1, 2 Robin Jeannet 2 Frédéric Vargas 30 Catherine Fleureau 30 Mickaël Roux 30 Kaoutar Allou 30 Philippe Vignon 1, 31, 2 Jean Feuillard 3 Bruno Francois 1, 31, * 
* Corresponding author
12 LIPNESS - Equipe LIPNESS (LNC - U1231)
LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
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 andlt;.01) and late (P andlt;.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; No. NCT01995448; URL © 2018 American College of Chest Physicians
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Thomas Daix, Estelle Guerin, Elsa Tavernier, Emmanuelle Mercier, Valérie Gissot, et al.. Multicentric Standardized Flow Cytometry Routine Assessment of Patients With Sepsis to Predict Clinical Worsening. Chest, American College of Chest Physicians, 2018, 154 (3), pp.617--627. ⟨10.1016/j.chest.2018.03.058⟩. ⟨hal-01881116⟩



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