Blood count derangements after sepsis and association with post-hospital outcomes

Denstaedt, Scott J.; Cano, Jennifer; Wang, Xiao Qing; Donnelly, John P.; Seelye, Sarah; Prescott, H.C.

doi:10.3389/fimmu.2023.1133351

Cited by 6 publications

(1 citation statement)

References 51 publications

(45 reference statements)

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“…ELISpot has emerged as a powerful method to assess immunological status in a variety of clinical disorders (25)(26)(27)(28), including septic and critically ill patients (20,21,29,30). It offers several theoretical advantages over other current metrics -for example, cell phenotypes such as ALC (31)(32)(33)(34) and HLA-DR expression on CD14 + blood cells (35,36); plasma protein concentrations such as procalcitonin (37)(38)(39)(40), IL-6 (41)(42)(43), and sPD-L1 (44,45); or blood transcriptomics (24,46,47) -used to predict both the severity of the host response and the immunosuppressed endotype. ELISpot, unlike these static measures, assesses one component of the functional status of the host protective immune response.…”

Section: Discussionmentioning

confidence: 99%

Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot

Barrios,

Mazer,

McGonagill

et al. 2024

JCI Insight

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predictive metrics in critical illness and this technology (provisional patent application 63/521,817) is evaluated in this research. SCB, LLM, RSH, and the University of Florida may receive royalty income based on a technology developed by SCB and others and licensed by Washington University in St. Louis to IFDx LLC. That technology is evaluated in this research. CCC and the University of Cincinnati may receive royalty income based on a technology developed by CCC and others and licensed by Washington University in St. Louis to IFDx LLC. That technology is evaluated in this research.

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Section: Discussionmentioning

confidence: 99%

Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot

Barrios,

Mazer,

McGonagill

et al. 2024

JCI Insight

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Adverse Long-Term Outcomes and an Immune Suppressed Endotype in Sepsis Patients with Reduced Interferon-γ ELISpot: A Multicenter, Prospective Observational Study

Barrios,

Mazer,

McGonagill

et al. 2023

Preprint

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Background: Sepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting clinical outcomes and immunological endotyping of septic patients has generally relied on using blood protein or mRNA biomarkers, or static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision. Methods: An ex vivo whole blood enzyme-linked immunosorbent (ELISpot) assay for cellular production of interferon-γ (IFN-γ) was evaluated in 107 septic and 68 non-septic patients from five academic health centers using blood samples collected on days 1, 4 and 7 following ICU admission. Results: Compared with 46 healthy subjects, unstimulated and stimulated whole blood IFNγ expression were either increased or unchanged, respectively, in septic and nonseptic ICU patients. However, in septic patients who did not survive 180 days, stimulated whole blood IFNγ expression was significantly reduced on ICU days 1, 4 and 7 (all p<0.05), due to both significant reductions in total number of IFNγ producing cells and amount of IFNγ produced per cell (all p<0.05). Importantly, IFNγ total expression on day 1 and 4 after admission could discriminate 180-day mortality better than absolute lymphocyte count (ALC), IL-6 and procalcitonin. Septic patients with low IFNγ expression were older and had lower ALC and higher sPD-L1 and IL-10 concentrations, consistent with an immune suppressed endotype. Conclusions: A whole blood IFNγ ELISpot assay can both identify septic patients at increased risk of late mortality, and identify immune-suppressed, sepsis patients.

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Preoperative Anemia Is Associated With Worse Postoperative Outcomes After Open Reduction Internal Fixation of Distal Radius Fractures

Schmerler,

Olson,

Prasad

et al. 2023

Hand (New York, N,Y.)

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Background: Preoperative anemia has been shown to be associated with complications after numerous orthopedic procedures. No studies to our knowledge have examined its impact on outcomes after open reduction internal fixation (ORIF) of distal radius fracture (DRF). We hypothesized that patients with preoperative anemia would have increased likelihood of adverse outcomes, and likelihood would increase with severity of anemia. Methods: A total of 14 136 patients underwent ORIF for DRF over 2012-2021, identified in the National Surgical Quality Improvement Program database. Patients were classified by World Health Organization criteria as nonanemic (hematocrit >36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), or moderately to severely anemic (hematocrit <33% for women or men). Multivariable regressions adjusted for age, sex, race, and comorbidities statistically different between anemic and nonanemic patients were used to examine the effect of anemia on postoperative outcomes. Results: Mildly anemic patients had significantly longer length of stay and were significantly more likely to experience readmission and sepsis ( P < .05 all). Moderately to severely anemic patients had significantly longer length of stay and were significantly more likely to experience readmission, postoperative transfusion, septic shock, and any adverse event ( P < .05 all). Conclusions: Preoperative anemia is associated with increased likelihood of adverse outcomes after ORIF for DRF, and likelihood increases with severity of anemia. Surgeons should monitor patients for preoperative anemia and endeavor to identify the source of and, if safe and possible, correct the anemia preoperatively or manage and educate patients postoperatively.

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Blood count derangements after sepsis and association with post-hospital outcomes

Cited by 6 publications

References 51 publications

Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot

Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot

Adverse Long-Term Outcomes and an Immune Suppressed Endotype in Sepsis Patients with Reduced Interferon-γ ELISpot: A Multicenter, Prospective Observational Study

Preoperative Anemia Is Associated With Worse Postoperative Outcomes After Open Reduction Internal Fixation of Distal Radius Fractures

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