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KMID : 0385920140250020167
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Journal of the Korean Society of Emergency Medicine
2014 Volume.25 No. 2 p.167 ~ p.173
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Validation of Immature Granulocyte as a Predictor for the 28-Day Mortality in Patients with Severe Sepsis and Septic Shock
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Ko Young-Sang
Ha Sang-Ook
Jeong Ru-Bi
Choi Byung-Ho
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Abstract
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Purpose: Recently, several studies for immature granulocyte proportion (IG%) in patients with sepsis have revealed its association with diagnosis and prognosis of patients with sepsis. In this study, we enrolled patients with severe sepsis and septic shock and compared IG% with other biologic markers as a predictor of 28-day mortality.
Methods: This was a retrospective study for patients with severe sepsis and septic shock who were admitted to the emergency department of a tertiary care hospital for fourmonths. The IG% measured using Sysmex XE-2100 and other inflammatory markers, including C-reactive protein, lactate, and procalcitonin were evaluated and compared for 28-day mortality.
Results: A total of 85 patients with septic shock and 45 patients with severe sepsis were enrolled. In the non-survivors group (n=32, 24.6%), APACHE II score (p=0.017), use of continuous renal replacement therapy (CRRT) (p=0.002), and septic shock (p=0.009) were statistically higher compared with thesurvivors group. APACHE 2 score (Odd ratio [OR] 1.099, p=0.008) and IG% (≥0.5%) (OR 3.568, p=0.036) predicted the 28-day mortality independently after adjusting SOFA score, septic shock, disseminated intravascular coagulopathy, use of CRRT, and gender. However, IG (≥0.5%) had low specificity of 33.7% and positive predictive value (PPV) of 30.1% for 28-day mortality.
Conclusion: IG% could be a useful biologic marker for prediction of 28-day mortality in patients with severe sepsis or septic shock. However, the limitation of low specificity and PPV must be considered in clinical use.
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KEYWORD
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Biologic markers, Granulocytes, Mortality, Sepsis
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