Evaluation of Immature Granulocyte Count as early marker of sepsis: a Prospective Observational study

INTRODUCTION : • Sepsis is a life threatening condition that can lead to shock , severe organ failure and even death. The mortality of severe sepsis in India reaches up to 65.2%(1). • It is the result of excessive activation of host defence mechanism to the invasion of normally sterile tissue ,fluid, or body cavity by pathogenic microorganism or to their toxic product presence in the circulation .i.e the body’s response to systemic infection rather than the direct effect of the microorganism(2,3). • Early detecÆŸon of infection, sepsis and multiorgan dysfunction is the key for successful management(1). • The Surviving Sepsis Campaign, recommend that antibiotic should be administered immediately, ideally within 1 hr of recognition for adult with possible septic shock or a high likelihood for sepsis(1,4). • Blood cultures are used to identify pathogens but the major disadvantage is the relatively long incubation period before establishing the diagnosis(1,5).False negative blood culture result might be due to prior treatment with antimicrobials, inappropriate culturing conditions for fastidious organisms, insufficient quantity of blood. False posivve blood culture result might be due to errors in collection or processing of the samples.(5) • Hence diagnosing an infection rapidly and accurately in very early SIRS is both challenging and vital for early induction of appropriate therapy. • Biomarker such as Procalcitonin(PCT),C-reactive protein(CRP),lactic acid(Lac),interleukin-6 (IL-6) are predictive biomarker(1,6).But are relatively of high cost (1). • Sepsis is characterised by marked increase in neutrophil production by bone marrow and recruitment of immature neutrophil i.e circulating non-segmented neutrophil (band cell) and immature granulocyte, into the circulation. This is usually referred to as “leÅŒ shiŌ”.(3,7) • Immature Granulocyte fraction of the neutrophil include promyelocyte, myelocyte, metamyelocyte which have better morphological definition.(1,7) Immature Granulocyte fraction is believed to be the first • reaction of the bone marrow to an infection and increased Immature granulocyte in peripheral blood indicate an enhanced bone marrow activity.(1,7,8) • According to certain studies, the immature granulocyte is a useful marker for to differentiate patients with sepsis from those with non infectious inflammation.(1,8) • Immature Granulocyte count(IG#) and Immature Granulocyte percentage(IG%) can be estimated as early predictor of sepsis. The modern automated cell counting machine allows simple, fast and inexpensive quantification of IG.(7,8)

METHOD AND MATERIALS : • After approval by the institutional ethical commttee, the study will be conducted under the Department of Anaesthesiology and Critical Care ,GMCH . The study will be carried on patients with clinical suspicion of infection admitted to the General ICU (GICU) under the Department of Anaesthesiology and Critical Care, in the 64 – bedded ICU complex of Gauhati Medical College and Hospital.

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