Sepsis represents a severe pathology that requires both rapid and precise positive and differential diagnosis to identify patients who need immediate antimicrobial therapy. Monitoring septic patients′ outcome leads to prolonged hospitalisation and antibacterial therapy, often accompanied by substantial side effects, complications and a high mortality risk. Septic patients present with complex pathophysiological and immunological disorders and with a predominance of pro-inflammatory or anti-inflammatory mediators which are heterogeneous with respect to the infectious focus, the aetiology of sepsis or patients′ immune status or comorbidities. Previous studies performed have analysed inflammatory biomarkers, but a test or combinations of tests that can quickly and precisely establish a diagnosis or prognosis of septic patients has yet to be discovered. Recent research has focused on re-analysing older accessible parameters found in the complete blood count to determine the sensitivity, specificity, positive and negative predictive values for the diagnosis and prognosis of sepsis. The neutrophil/lymphocyte count ratio (NLCR), mean platelet volume (MPV) and red blood cells distribution width (RDW) are haemogram indicators which have been evaluated and which are of proven use in septic patients′ management.
1. Cho WH. Update of Sepsis: Recent Evidences about Early Goal Directed Therapy. Tuberc Respir Dis (Seoul). 2015;78(3):156-160.
2. Esper AM, Martin GS. Extending international sepsis epidemiology: the impact of organ dysfunction. Crit Care. 2009;13(1):120.
3. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012;10(6):701-6.
4. Esteban A, Frutos-Vivar F, Ferguson ND, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med. 2007;35(5):1284-9.
5. Levy MM, Fink MP, Marshall JC, et al. 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Intensive Care Med. 2003;29(4):530-8.
6. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775-87.
7. Joshi VD, Kalvakolanu DV, Cross AS. Simultaneous activation of apoptosis and inflammation in pathogenesis of septic shock: a hypothesis. FEBS Lett. 2003;555(2):180-4.
8. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.
9. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophillymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91(3):181-4.
10. Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 2009;250(1):141-51.
11. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102(6):653-7.
12. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995-1002.
13. Ertaş G, Sönmez O, Turfan M, et al. Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation. J Neurol Sci. 2013;324(1):49-52.
14. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2013;97(4):299-304.
15. de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophillymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit care. 2010;14(5):R192.
16. Okashah AS, El-Sawy MM, Beshay BN, Abd El-Raouf A. Ratio of Neutrophil to Lymphocyte counts as a simple marker for sepsis and severe sepsis in Intensive Care Unit. Res Opin Anesth Intensive Care. 2014;2:39-45.
17. Terradas R, Grau S, Blanch J, et al. Eosinophil count and neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PloS One. 2012;7(8):e42860.
18. Orfanu A, Aramă V, Aramă ŞS, et al. The diagnostic and prognostic role of neutrophil to lymphocyte count ratio in sepsis. BMC Infect Dis. 2016;16(4):A5.
19. Zampieri FG, Ranzani OT, Sabatoski V, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care. 2014;4:20.
20. Van der Lelie J, Von dem Borne AK. Increased mean platelet volume in septicaemia. J Clin Pathol. 1983;36(6):693-6.
21. Eberhardt A, Lessig F, Schreiter K, et al. Mean platelet volume (MPV) is an outcome marker in sepsis patients. Int J Infect Dis. 2012;16:e218.
22. Orfanu A, Popescu C, Leustean A, et al. The evaluation of the prognostic value of procalcitonin, mean platelet volume and neutrophil/lymphocytes ratio in sepsis. The Scientific Days of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals”. Abstract Volume - ID in ID or Identity Definition in Infectious Diseases 2015;17.
23. Guclu E, Durmaz Y, Karabay O. Effect of severe sepsis on platelet count and their indices. Afr Health Sci. 2013;13(2):333-8.
24. Sadaka F, Donnelly PL, Griffin MT, Brien JO, Lakshmanan R. Mean Platelet Volume is not a Useful Predictor of Mortality in Septic Shock. Blood Disorders Transf. 2014;5:2.
25. Oncel MY, Ozdemir R, Yurttutan S, et al. Mean Platelet Volume in Neonatal Sepsis. J Clin Lab Anal. 2012;26(6):493-6.
26. Karadag-Oncel E, Ozsurekci Y, Kara A, Karahan S, Cengiz AB, Ceyhan M. The value of mean platelet volume in the determination of community acquired pneumonia in children. Ital J Pediatr. 2013;39(1):16.
27. Ki YJ, Park S, Ha SI, Choi DH, Song H. Usefulness of mean platelet volume as a biomarker for long-term clinical outcomes after percutaneous coronary intervention in Korean cohort: a comparable and additive predictive value to high-sensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide. Platelets. 2014;25(6):427-32.
28. D’erasmo E, Aliberti G, Celi FS, Romagnoli E, Vecci E, Mazzuoli GF. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J. Intern. Med. 1990;227(1):11-4.
29. Scharte M, Fink MP. Red blood cell physiology in critical illness. Crit Care Med. 2003;31(12):S651-7.
30. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50(3):301-12.
31. Mahmood NA, Mathew J, Kang B, DeBari VA, Khan MA. Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis. Int J Crit Illn Inj Sci. 2014;4(4):278-282.
32. Kim S, Lee K, Kim I, Jung S, Kim MJ. Red cell distribution width and early mortality in elderly patients with severe sepsis and septic shock. Clin Exp Emerg Med. 2015;2(3):155-161.
33. Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann. Med. 2011;43(1):40-6.
34. Kim CH, Park JT, Kim EJ, et al. An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit Care. 2013;17(6):R282.
35. Chen CK, Lin SC, Wu CC, Chen LM, Tzeng IS, Chen KF. STARDcompliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department. Medicine. 2016;95(24):e3692.
36. Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PloS One. 2014;9(8):e105436.
37. Jekarl DW, Lee SJ, Lee J, et al. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis. Diagn Microbiol Infect Dis 2013;75:342-7.
38. Klag T, Cantara G, Sechtem U, Athanasiadis A. Interleukin-6 kinetics can be useful for early treatment monitoring of severe bacterial sepsis and septic shock. Infect Dis Rep. 2016; 8(1):6213.
39. Henriquez-Camacho C, Losa J. Biomarkers for sepsis. BioMed research international. 2014;2014:547818.
40. Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophillymphocyte count ratio for sepsis. Exp Ther Med. 2016;12(4):2215-9.