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J Korean Soc Emerg Med > Volume 25(2); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(2): 167-173.
Validation of Immature Granulocyte as a Predictor for the 28-Day Mortality in Patients with Severe Sepsis and Septic Shock
Young Sang Ko, Sang Ook Ha, Rubi Jeong, Byungho Choi
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. loneness@naver.com
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.
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 four-months. 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.
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 II score (Odd ratio [OR] 1.099, p=0.008) and IG% (> or =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 (> or =0.5%) had low specificity of 33.7% and positive predictive value (PPV) of 30.1% for 28-day mortality.
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.
Key words: Biologic markers, Granulocytes, Mortality, Sepsis
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