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Neutrophil Fluorescence: A New Indicator of Cell Activation During Septic Shock–Induced Disseminated Intravascular Coagulation

Stiel, Laure MD; Delabranche, Xavier MD, PhD; Galoisy, Anne-Cécile MD; Severac, François MD; Toti, Florence PhD; Mauvieux, Laurent MD, PhD; Meziani, Ferhat MD, PhD; Boisramé-Helms, Julie MD, PhD

doi: 10.1097/CCM.0000000000001851
Online Brief Report

Objective: To investigate the contribution of neutrophil activation as innate immune cells during septic shock–induced disseminated intravascular coagulation.

Design: Prospective study.

Setting: One University Hospital ICU.

Participants: Hundred patients with septic shock. Thirty-five patients had disseminated intravascular coagulation according to Japanese Association for Acute Medicine 2006 score.

Intervention: None.

Measurements and Main Results: Neutrophil chromatin decondensation was assessed by measuring neutrophil fluorescence (NEUT-side-fluorescence light) labeled by a fluorochrome-based polymethine reagent using a routine automated flow cytometer Sysmex XN20 (Sysmex, Kobe, Japan) and neutrophil-derived CD66b microparticles by prothrombinase assay. Measurements in disseminated intravascular coagulation and no disseminated intravascular coagulation patients showed that a mean value of NEUT-side-fluorescence light above 57.3 arbitrary units had a sensitivity of 90.91% and a specificity of 80.60% for disseminated intravascular coagulation diagnosis. NEUT-side-fluorescence light was correlated to the CD66b microparticles/neutrophil count, a surrogate of neutrophil activation associated with septic shock–induced disseminated intravascular coagulation.

Conclusion: NEUT-side-fluorescence light, routinely available, could prove an accurate biomarker of neutrophil activation.

1Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

2EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France.

3Laboratoire d’hématologie et hémostase, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

4Laboratoire de Biostatistique et d’Informatique Médicale, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

5Groupe Méthode en Recherche Clinique, Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

6UMR 7213 CNRS, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France.

7EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France.

Drs. Stiel and Delabranche contributed equally to this work. Drs. Stiel, Delabranche, Meziani, and Boisramé-Helms had full access to all the study data and take responsibility for their integrity and the accuracy of their analysis. Drs. Stiel, Delabranche, Mauvieux, Meziani, and Boisramé-Helms participated in the study design and obtained funding for the study. Drs. Stiel, Delabranche, Meziani, and Boisramé-Helms collected the data. Drs. Stiel, Delabranche, Galoisy, Toti, Mauvieux, and Meziani analyzed the data. Drs. Stiel, Delabranche, Galoisy, and Toti performed biological analyses. Drs. Stiel, Delabranche, Meziani, and Boisramé-Helms drafted the report, and the report was revised for important intellectual content by Drs. Stiel, Delabranche, Galoisy, Toti, Mauvieux, Meziani, and Boisramé-Helms. All authors read and approved the final article.

Supported, in part, by the Association pour le Développement et la Recherche en Réanimation (ADRER) (Strasbourg, France) and Association D’aide aux Insuffisants Respiratoires d’Alsace-Lorraine (ADIRAL) Association (Strasbourg, France).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: ferhat.meziani@chru-strasbourg.fr

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