Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery

Abstract

Background Similarly, to sepsis, cardiac surgery with cardiopulmonary bypass (CPB) induces major changes in leukocyte subsets. Immature granulocytes (IGs) increase both in sepsis and after open‐heart surgery. Secondary infections are a major complication of cardiac surgery with CPB. We hypothesized that the assessment of leukocyte subsets with multicolor flow cytometry (FCM) could help the front‐line clinician to better identify patients at high risk of infectious complications in this clinical setting. Methods In this single‐center observational pilot study, we identified 26 leukocyte subsets using three combinations of antibodies (from 5 to 10 colors per combinations): one devoted to granulocytes, one to lymphocyte subpopulations and one for rare cells (plasma cells and dendritic cells). Blood samples were obtained preoperatively and immediately after open‐heart surgery under CPB in 59 patients without immuno‐depression, chronic or neoplastic inflammatory disease, and immunosuppressive treatment. Secondary infections during hospital stay were recorded. Results Patients exhibited postoperative NK and T‐cell lymphopenia, increased levels of IGs and monocytes with low levels of surface HLA DR. Twelve patients developed secondary infectious complications. Only immediate postoperative IG levels were significantly higher in these patient (6.6 [6; 7.39] G/L vs. 3.8 [2.67; 5.72] G/L, P = 0.01). Patients with immediate postoperative increase of IGs developed more frequently infectious complication (10/22 [46%] vs. 2/37 [5%]: P < 0.001). Conclusions This study suggests that postoperative increase of IGs is related to postoperative organ failure and promises to help in early identification of patients at risk of infectious complications after open‐heart surgery under CPB. © 2018 International Clinical Cytometry Society

Myeloid-Derived Suppressor Cells in Sepsis

“…In an earliest study using automated IG counting on a small number of patients, the percentage of IG was higher in infected than in uninfected patients and was proposed to be a predictor of sepsis (93). Retrospective and prospective observational studies confirmed that IG proportion discriminates between infected and uninfected patients and is associated with disease severity (94–99) (Table 1). Automated cell counters can determine a delta neutrophil index (DNI), which reflects the number of immature neutrophils in the blood.…”

Predictive value of immature granulocyte in the diagnosis of acute complicated appendicitis

“…As a result of the bone marrow produces more leukocytes and immature granulocytes migrate to the peripheral blood, a left shift is observed in the origin of leukocytes [ 9 ]. In previous studies, immature granulocytes were found to be significantly higher in inflammatory conditions such as pancreatitis, sickle cell disease, liver abscess, and infective complications after cardiac surgery [ 14 – 17 ]. Kilercik et al also found significantly higher IG levels in Covid 19 patients [ 18 ].…”

The Immature Granulocyte Count Is a New Predictor of the 30-Day Mortality in Intracerebral Haemorrhage Patients: Preliminary Study

“…Furthermore, studies have found out that the granulocyte count is significantly high in many inflammatory conditions such as acute appendicitis, liver abscesses, and infective complications after cardiac surgery. 26,27 Huang et al 8 reported that a high IG count can predict the risk of acute respiratory distress syndrome (ARDS) early in patients with acute pancreatitis. Another study by Lipinski et al 28 showed that an IG count of 0.6 and above had high specificity and sensitivity in demonstrating acute pancreatitis complications.…”