Diagnostic and predictive value of white blood cell population data in patients with sepsis

doi:10.3969/j.issn.1673-8640.2025.03.012

Abstract

Abstract:

Objective To investigate the diagnostic value of white blood cell population data （CPD）in patients with sepsis. Methods Totally，44 sepsis patients admitted to Shanghai East Hospital of Tongji University School of Medicine from January 2022 to May 2022 were enrolled，and 27 patients with pulmonary infection，and 20 healthy subjects were enrolled as well. CPD，C-reactive protein（CRP）and procalcitonin（PCT）were determined and analyzed to establish diagnostic model. Receiver operating characteristic（ROC）curve was used to evaluate the efficiency for the diagnosis of sepsis. A total of 70 sepsis patients from June 2022 to January 2023 at Shanghai East Hospital of Tongji University were enrolled for cross validation. Results In sepsis group，neutrophil fluorescence intensity（NE-SFL），width of dispersion of neutrophil fluorescence（NE-WY） and monocyte complexity（MO-X）were 50.40（46.65，55.20），717.5（642.3，832.5），123.4（120.9，125.7），respectively，which were higher than those in healthy control group [43.60（43.03，46.88），579.0（558.5，595.8），119.7（118.6，121.0）]（P<0.05） and those in pulmonary infection group [46.45（44.73，49.00），616.5（589.8，634.5），120.8（119.3，122.7）]（P<0.05）. The areas under curves of NE-SFL，NE-WY，MO-X，CRP and PCT were 0.734，0.841，0.727，0.817 and 0.862，respectively. The sensitivities of NE-SFL，NE-WY，MO-X，CRP and PCT were 61.9%，77.4%，44.0%，87.8% and 88.6%，respectively. The specificities were 80.0%，84.0%，92.0%，69.4% and 71.4%，respectively. The cross validation results showed that the true positive rates of NE-SFL，NE-WY，MO-X，CRP and PCT were 71.83%，91.55%，47.89%，73.02% and 82.61%，respectively. The false negative rates were 28.17%，8.45%，52.11%，26.98% and 17.39%，respectively. The positive rate of NE-WY before diagnosis for 5 d was higher than those of PCT and CRP，while the positive rates of NE-SFL and MO-X were lower than those of PCT and CRP. The positive time of blood culture was delayed compared to NE-SFL，NE-WY，MO-X，CRP and PCT. Conclusions CPD have certain predictive value in the diagnosis of sepsis. The diagnostic efficacy of NE-WY is superior to that of PCT. The diagnostic efficacy of NE-SFL is similar to that of CRP. The combined diagnosis of sepsis using NE-WY and PCT has better diagnostic efficacy.

Key words: White blood cell population datum, Sepsis, Neutrophil, Monocyte, Procalcitonin, C-reactive protein

CLC Number:

R446.11

ZHANG Haoyang, LU Lin, ZONG Ming, HE Long, DING Yuanyuan, FAN Lieying. Diagnostic and predictive value of white blood cell population data in patients with sepsis[J]. Laboratory Medicine, 2025, 40(3): 271-277.

Figures/Tables 6

References 26

[1]	SINGER M, DEUTSCHMAN C S, SEYMOUR C W, et al. The third international consensus definitions for sepsis and septic shock(sepsis-3)[J]. JAMA, 2016, 315(8):801-810.
[2]	FLEISCHMANN C, SCHERAG A, ADHIKARI N K, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations[J]. Am J Respir Crit Care Med, 2016, 193(3):259-272.
[3]	GYAWALI B, RAMAKRISHNA K, DHAMOON A S. Sepsis:the evolution in definition,pathophysiology,and management[J]. SAGE Open Med, 2019, 7:2106907043.
[4]	SHASHIKUMAR S P, STANLEY M D, SADIQ I, et al. Early sepsis detection in critical care patients using multiscale blood pressure and heart rate dynamics[J]. J Electrocardiol, 2017, 50(6):739-743. DOI PMID
[5]	MORTAZ E, ALIPOOR S D, ADCOCK I M, et al. Update on neutrophil function in severe inflammation[J]. Front Immunol, 2018, 9:2171. DOI PMID
[6]	LI Y, WANG W, YANG F, et al. The regulatory roles of neutrophils in adaptive immunity[J]. Cell Commun Signal, 2019, 17(1):147. DOI PMID
[7]	MARTINS P S, KALLAS E G, NETO M C, et al. Upregulation of reactive oxygen species generation and phagocytosis,and increased apoptosis in human neutrophils during severe sepsis and septic shock[J]. Shock, 2003, 20(3):208-212.
[8]	TAK T, VAN GROENENDAEL R, PICKKERS P, et al. Monocyte subsets are differentially lost from the circulation during acute inflammation induced by human experimental endotoxemia[J]. J Innate Immun, 2017, 9(5):464-474. DOI PMID
[9]	YONA S, JUNG S. Monocytes:subsets,origins,fates and functions[J]. Curr Opin Hematol, 2010, 17(1):53-59.
[10]	XU D. Clinical applications of leukocyte morphological parameters[J]. Int J Pathol Clin Res, 2015, 1:1-4.
[11]	EVANS L, RHODES A, ALHAZZANI W, et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47(11):1181-1247.
[12]	曹钰, 柴艳芬, 邓颖, 等. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 临床急诊杂志, 2018, 19(9):567-588.
[13]	LARSEN F F, PETERSEN J A. Novel biomarkers for sepsis:a narrative review[J]. Eur J Intern Med, 2017, 45:46-50.
[14]	KARON B S, TOLAN N V, WOCKENFUS A M, et al. Evaluation of lactate,white blood cell count,neutrophil count,procalcitonin and immature granulocyte count as biomarkers for sepsis in emergency department patients[J]. Clin Biochem, 2017, 50(16-17):956-958.
[15]	FAIX J D. Biomarkers of sepsis[J]. Crit Rev Clin Lab Sci, 2013, 50(1):23-36.
[16]	LIPPI G. Sepsis biomarkers:past,present and future[J]. Clin Chem Lab Med, 2019, 57(9):1281-1283.
[17]	HORECZKO T, GREEN J P, PANACEK E A. Epidemiology of the Systemic Inflammatory Response Syndrome(SIRS)in the emergency department[J]. West J Emerg Med, 2014, 15(3):329-336.
[18]	NAUSEEF W M, BORREGAARD N. Neutrophils at work[J]. Nat Immunol, 2014, 15(7):602-611. DOI PMID
[19]	URRECHAGA E, BOVEDA O, AGUIRRE U. Role of leucocytes cell population data in the early detection of sepsis[J]. J Clin Pathol, 2018, 71(3):259-266. DOI PMID
[20]	BUORO S, SEGHEZZI M, VAVASSORI M, et al. Clinical significance of cell population data(CPD)on Sysmex XN-9000 in septic patients with our without liver impairment[J]. Ann Transl Med, 2016, 4(21):418.
[21]	朱美英, 曹鄂洪. 降钙素原的检测和应用——《感染相关生物标志物临床意义解读专家共识》解读[J]. 上海医药, 2018, 39(1):14-18.
[22]	PARK S H, PARK C J, LEE B R, et al. Sepsis affects most routine and cell population data(CPD)obtained using the Sysmex XN-2000 blood cell analyzer:neutrophil-related CPD NE-SFL and NE-WY provide useful information for detecting sepsis[J]. Int J Lab Hematol, 2015, 37(2):190-198.
[23]	TANG H, JING J, BO D, et al. Biological variations of leukocyte numerical and morphologic parameters determined by UniCel DxH 800 hematology analyzer[J]. Arch Pathol Lab Med, 2012, 136(11):1392-1396. DOI PMID
[24]	ARORA P, GUPTA P K, LINGAIAH R, et al. Volume,conductivity,and scatter parameters of leukocytes as early markers of sepsis and treatment response[J]. J Lab Physicians, 2019, 11(1):29-33.
[25]	PEREZ I, REDIN M E. Stability of leukocyte research parameters over time on the Sysmex XN:how to quantify the changes in cell morphology[J]. Int J Lab Hematol, 2018, 40(5):569-576.
[26]	SEGHEZZI M, BUORO S, PREVITALI G, et al. A preliminary proposal for quality control assessment and harmonization of leukocytes morphology-structural parameters(cell population data parameters)[J]. J Med Biochem, 2018, 37(4):486-498.

组别	例数	性别		年龄/岁	白细胞计数/（×109·L^-1）	中性粒细胞百分比%
组别	例数	男/例	女/例	年龄/岁	白细胞计数/（×109·L^-1）	中性粒细胞百分比%
脓毒血症组	44	31	13	75.00（66.00，84.00）*	14.43（10.31，21.39）*#	86.50（80.13，93.00）*#
肺炎组	27	14	13	81.00（68.00，86.00）*	7.68（5.67，9.40）	71.35（61.60，81.88）*
健康对照组	20	11	9	29.00（25.25，32.75）	5.55（4.82，6.68）	56.20（49.33，60.38）
统计值		2.900		43.551	65.218	72.120
P值		0.233		<0.001	<0.001	<0.001
组别	单核细胞百分比/%			血红蛋白/（g·L^-1）	血小板/（×109·L^-1）	CRP/（mg·L^-1）
脓毒血症组	5.80（3.15，7.58）#			107.56±29.29*#	178.00（103.00，261.25）#	90.09（32.05，189.17）#
肺炎组	8.00（6.18，9.05）			116.24±16.72*	249.50（144.50，309.50）	16.19（5.22，38.52）
健康对照组	7.35（6.43，7.68）			143.55±12.74#	255.00（214.75，281.00）
统计值	17.857			18.023	13.630	-5.910
P值	<0.001			<0.001	<0.001	<0.001
组别	血清淀粉样蛋白A/（mg·L^-1）				PCT/（ng·mL^-1）	白细胞介素-6/（pg·mL^-1）
脓毒血症组	225.86（79.26，288.00）#				2.14（0.24，30.57）#	115.40（28.00，766.15）#
肺炎组	23.60（8.78，119.61）				0.10（0.06，0.21）	13.92（7.52，28.63）
健康对照组
统计值	-4.160				-6.610	-5.690
P值	<0.001				<0.001	<0.001

组别	例数	性别		年龄/岁	白细胞计数/（×109·L^-1）	中性粒细胞百分比%
组别	例数	男/例	女/例	年龄/岁	白细胞计数/（×109·L^-1）	中性粒细胞百分比%
脓毒血症组	44	31	13	75.00（66.00，84.00）*	14.43（10.31，21.39）*#	86.50（80.13，93.00）*#
肺炎组	27	14	13	81.00（68.00，86.00）*	7.68（5.67，9.40）	71.35（61.60，81.88）*
健康对照组	20	11	9	29.00（25.25，32.75）	5.55（4.82，6.68）	56.20（49.33，60.38）
统计值		2.900		43.551	65.218	72.120
P值		0.233		<0.001	<0.001	<0.001
组别	单核细胞百分比/%			血红蛋白/（g·L^-1）	血小板/（×109·L^-1）	CRP/（mg·L^-1）
脓毒血症组	5.80（3.15，7.58）#			107.56±29.29*#	178.00（103.00，261.25）#	90.09（32.05，189.17）#
肺炎组	8.00（6.18，9.05）			116.24±16.72*	249.50（144.50，309.50）	16.19（5.22，38.52）
健康对照组	7.35（6.43，7.68）			143.55±12.74#	255.00（214.75，281.00）
统计值	17.857			18.023	13.630	-5.910
P值	<0.001			<0.001	<0.001	<0.001
组别	血清淀粉样蛋白A/（mg·L^-1）				PCT/（ng·mL^-1）	白细胞介素-6/（pg·mL^-1）
脓毒血症组	225.86（79.26，288.00）#				2.14（0.24，30.57）#	115.40（28.00，766.15）#
肺炎组	23.60（8.78，119.61）				0.10（0.06，0.21）	13.92（7.52，28.63）
健康对照组
统计值	-4.160				-6.610	-5.690
P值	<0.001				<0.001	<0.001

组别	NE-SFL	NE-WY	NE-WZ	MO-X	MO-WX	MO-WZ
脓毒血症组	50.40 （46.65，55.20）*#	717.5 （642.3，832.5）*#	651.5 （614.0，713.5）*	123.4 （120.9，125.7）*#	267.5 （248.8，293.3）#	577.0 （539.8，631.5）*
肺炎组	46.45 （44.73，49.00）	616.5 （589.8，634.5）*	642.0 （604.0，701.0）	120.8 （119.3，122.7）	248.0 （235.0，271.3）*	590.5 （551.5，656.8）
健康对照组	43.60 （43.03，46.88）	579.0 （558.5，595.8）	615.5 （587.5，642.0）	119.7 （118.6，121.0）	276.0 （254.3，290.5）	536.0 （511.0，583.5）
统计值	39.632	70.366	8.978	33.800	12.705	7.928
P值	<0.001	<0.001	0.011	<0.001	0.002	0.019

组别	NE-SFL	NE-WY	NE-WZ	MO-X	MO-WX	MO-WZ
脓毒血症组	50.40 （46.65，55.20）*#	717.5 （642.3，832.5）*#	651.5 （614.0，713.5）*	123.4 （120.9，125.7）*#	267.5 （248.8，293.3）#	577.0 （539.8，631.5）*
肺炎组	46.45 （44.73，49.00）	616.5 （589.8，634.5）*	642.0 （604.0，701.0）	120.8 （119.3，122.7）	248.0 （235.0，271.3）*	590.5 （551.5，656.8）
健康对照组	43.60 （43.03，46.88）	579.0 （558.5，595.8）	615.5 （587.5，642.0）	119.7 （118.6，121.0）	276.0 （254.3，290.5）	536.0 （511.0，583.5）
统计值	39.632	70.366	8.978	33.800	12.705	7.928
P值	<0.001	<0.001	0.011	<0.001	0.002	0.019

项目	AUC（95%可信区间）	P值	最佳临界值	敏感性/%	特异性/%	阳性预测值	阴性预测值	约登指数
NE-SFL	0.734（0.650~0.819）	<0.001	49.30	61.9	80.0	83.87	55.56	0.419
NE-WY	0.841（0.774~0.909）	<0.001	641.00	77.4	84.0	87.67	68.85	0.614
MO-X	0.727（0.641~0.813）	<0.001	124.05	44.0	92.0	90.24	49.46	0.360
CRP	0.817（0.743~0.891）	<0.001	55.54	87.8	69.4	89.29	66.15	0.572
PCT	0.862（0.799~0.925）	<0.001	0.29	88.6	71.4	85.00	65.57	0.601
NE-SFL+NE-WY+MO-X	0.884（0.825~0.943）	<0.001	0.509	81.0	86.0	79.79	77.50	0.67
NE-WY+PCT	0.924（0.875~0.972）	<0.001	0.590	80.5	95.5	87.06	91.43	0.76