The Potential Role of Neutrophil-Reactive Intensity (NEUT-RI) in the Diagnosis of Sepsis in Critically Ill Patients: A Retrospective Cohort Study

Abstract

The diagnosis of sepsis is often difficult and belated, substantially increasing mortality in affected patients. Its early identification allows for us to choose the most appropriate therapies in the shortest time, improving patients’ outcomes and eventually their survival. Since neutrophil activation is an indicator of an early innate immune response, the aim of the study was to evaluate the role of Neutrophil-Reactive Intensity (NEUT-RI), which is an indicator of their metabolic activity, in the diagnosis of sepsis. Data from 96 patients consecutively admitted to the Intensive Care Unit (ICU) were retrospectively analyzed (46 patients with and 50 without sepsis). Patients with sepsis were further divided between sepsis and septic shock according to the severity of the illness. Patients were subsequently classified according to renal function. For the diagnosis of sepsis, NEUT-RI showed an AUC of >0.80 and a better negative predictive value than Procalcitonin (PCT) and C-reactive protein (CRP) (87.4% vs. 83.9% and 86.6%, p = 0.038). Unlike PCT and CRP, NEUT-RI did not show a significant difference within the “septic” group between patients with normal renal function and those with renal failure (p = 0.739). Similar results were observed among the “non-septic” group (p = 0.182). The increase in NEUT-RI values could be useful in the early ruling-out of sepsis, and it does not appear to be influenced by renal failure. However, NEUT-RI has not proved to be efficient in discriminating the severity of sepsis at the time of admission. Larger, prospective studies are needed to confirm these results.

A Secondary Retrospective Analysis of the Predictive Value of Activated Neutrophils (NEUT-RI) in Septic and Non-septic Patients in Intensive Care

“…In our investigation, PCT emerged as a valuable biomarker for sepsis diagnosis, maintaining a consistent best cut-off value of 2.17 ng/mL, in line with the previous study [19]. The sensitivity, though slightly reduced to 62.9% from the earlier 69.6%, is counterbalanced by a worthily high specificity of 82.9%, only marginally lower than the previous study's [19]. CRP, acknowledged as an acute-phase inflammatory marker indicative of the acute phase of sepsis [24], confirmed its diagnostic utility in our study.…”

“…CRP, acknowledged as an acute-phase inflammatory marker indicative of the acute phase of sepsis [24], confirmed its diagnostic utility in our study. The results demonstrated a robust sensitivity of 84.6%, surpassing the prior 80.4% [19]. However, this gain in sensitivity is accompanied by a decrease in specificity to 56.2%, compared to the earlier 70.7%.…”

“…Our study corroborates this phenomenon, revealing a significant difference between the "septic" and "non-septic" patient groups in terms of PCT, CRP, and the extended inflammatory parameter NEUT-RI. Through the inclusion of a larger population compared to previous study [19], NEUT-RI has once again demonstrated worthy diagnostic efficacy. The optimal cut-off value is identified as 50.75 FI, surpassing the previous threshold of 51.9 FI.…”

“…A comprehensive retrospective observational analysis of electronic medical records was performed to evaluate the diagnostic efficacy of NEUT-RI. The existing database, including patient information spanning from March 2022 to November 2022, underwent thorough scrutiny and augmentation, with data collection extending until October 2023 [19]. Clinical data of patients upon admission to ICU (clinical diagnosis, proximal and remote medical history for enrollment and exclusion criteria from the study), their respective laboratory values (WBC, PCR, PCT, extended inflammatory parameters, creatinine), blood culture results, SOFA score and SAPS II for severity assessment were collected.…”

Modern hemogram parameters in the diagnosis of infectious pathology

“…Российский журнал персонализированной медицины. 2023;3 (4):66-76. DOI: 10.18705/2782-3806-2023-3-4-66-76.…”