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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 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
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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https://www.hal.inserm.fr/hal-01881116
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UNIV-BOURGOGNE | FNCLCC | UMR645 | LNC-UMR866 | UR1-UFR-SVE | MICMAC | UNIV-NANTES | UNIV-RENNES | CRTI | USPC | UNIV-PARIS5 | EPHE | UPEC-UPEM | CIC203 | UNIV-RENNES1 | CGFL | BIOSIT | CIC | LNC-LIPNESS | CRIBL | UNILIM | GEIST | CNRS | UNIV-FCOMTE | UNIV-TOURS | U917 | INRA | IMRB | UPEC | UNIV-MONTPELLIER | INRAE | UNIV-PARIS | UP-SANTE | PSL

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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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