• Sabrina Buoro, Tommaso Mecca, Giovanna Azzarà, Sara Apassiti Esposito, Michela Seghezzi, Mauro Vavassori, Alberto Crippa, Gianmariano Marchesi, Enrico Castellucci, Cosimo Ottomano, and Giuseppe Lippi.
• 1 Laboratory of Clinical Chemistry, 2 Intensive Care Unit, 3 Department of Urology, Hospital Papa Giovanni XXIII, Bergamo, Italy ; 4 CAM Laboratory S.p.A., Monza, Italy ; 5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
• Ann Transl Med. 2015 Oct 1;3(17):244.

BackgroundSepsis is still a major cause of death in intensive care units (ICUs) worldwide. Patients with liver impairment express an imbalanced cytokine response which alters common sepsis biphasic nature. Cytokines measurement is expensive, often unavailable, whereas leukocytes (WBC) evaluation performed through hematology analyzers can provide a practical strategy for monitoring inflammatory response.MethodsA total of 200 healthy subjects (HS) and 84 patients (18 with, 66 without liver impairment) admitted to ICU, were assessed for International Sepsis Definitions, Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scores. We tested 1,022 peripheral blood samples using Sysmex XN-9000, estimating diagnostic accuracy of leukocyte differential count and nontraditional parameters through receiver operating characteristics (ROC) curves analysis compared to clinical classification.ResultsMedian value of all-leukocyte parameters was different in ICU patients compared to HS. Leukocytes, neutrophils (NE) and immature granulocytes (IGs) in sepsis and septic shock (SS) were higher than no sepsis (NS), with an area under the curve: 0.81, 0.82 and 0.78 respectively. Lymphocytes (LY) and monocytes (MO) were significantly associated with liver impairment.ConclusionsDiagnostic accuracy of all-leukocyte parameters may provide valuable information for diagnosis and follow-up of sepsis in ICU patients, especially those with liver impairment.

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