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

Thomas Daix; Estelle Guerin; Elsa Tavernier; Emmanuelle Mercier; Valérie Gissot; Olivier Herault; Jean-Paul Mira; Florence Dumas; Nicolas Chapuis; Christophe Guitton; Marie C Béné; Jean-Pierre Quenot; Cindy Tissier; Julien Guy; Gaël Piton; Anne Roggy; Grégoire Muller; Éric Legac; Nicolas Prost; Mehdi Khellaf; Orianne Wagner-Ballon; Rémi Coudroy; Elodie Dindinaud; Fabrice Uhel; Mikaël Roussel; Thomas Lafon; Robin Jeannet; Frédéric Vargas; Catherine Fleureau; Mickaël Roux; Kaoutar Allou; Philippe Vignon; Jean Feuillard; Bruno Francois

doi:10.1016/j.chest.2018.03.058

Journal articles

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 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

1 CIC1435 - Centre d'Investigation Clinique de Limoges

2 CHU Limoges

3 CRIBL - Contrôle de la Réponse Immune B et des Lymphoproliférations

4 CIC Tours

5 CHRU TOURS - Centre Hospitalier Régional Universitaire de Tours

6 CIC - Tours

7 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]

8 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire

9 ITUN - Institut de transplantation urologie-néphrologie

10 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie

11 CHU Nantes - Centre hospitalier universitaire de Nantes

12 LIPNESS - Equipe LIPNESS (LNC - U1231)

LNC - Lipides - Nutrition - Cancer [Dijon - U1231]

13 Service de Réanimation Médicale (CHU de Dijon)

14 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques

15 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand

16 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]

17 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920)

18 CHRU Besançon - Centre Hospitalier Régional Universitaire [Besançon]

19 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)

20 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer

21 Réanimation Médicale [CHR d'Orléans]

22 Hématologie Biologique [CHR d'Orléans]

23 DHU A-TVB - Réanimation Médicale [CHU Henri Mondor - APHP]

24 Hôpital Henri Mondor

25 IMRB - Institut Mondor de Recherche Biomédicale

26 CHU Poitiers - Centre hospitalier universitaire de Poitiers

27 CIC - Centre d'Investigation Clinique [Rennes]

28 MICMAC - Microenvironment, Cell Differentiation, Immunology and Cancer

29 CHU Pontchaillou [Rennes]

30 CHU Bordeaux [Bordeaux]

31 RESINFIT - Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques

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 ClinicalTrials.gov; No. NCT01995448; URL www.clinicaltrials.gov © 2018 American College of Chest Physicians

Keywords : flow cytometry immunosuppression inflammation prognosis sepsis

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Journal articles

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Life Sciences [q-bio] / Immunology

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

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