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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Diagnostic Accuracy of Immature Platelet Fraction, Immature Reticulocyte Fraction, and Immature Granulocyte
Arushi Choudhary1, Shubhransu Patro1, Sidharth S Pattnaik1
1Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Insights
Immature platelet fraction (IPF), immature reticulocyte fraction (IRF), and immature granulocyte percentage (IGP) show high accuracy in diagnosing sepsis. These biomarkers, particularly IPF and IRF, are valuable for early sepsis detection and monitoring patient recovery.
Area of Science:
- Hematology
- Critical Care Medicine
- Biomarker Discovery
Background:
- Sepsis poses a significant global mortality risk, necessitating rapid and precise diagnostic methods.
- Immature platelet fraction (IPF), immature reticulocyte fraction (IRF), and immature granulocyte percentage (IGP) are emerging as potential early sepsis biomarkers.
- Evaluating these immature cell fractions is crucial for improving sepsis diagnosis and patient outcomes.
Purpose of the Study:
- To assess the diagnostic utility of IPF, IRF, and IGP in sepsis patients.
- To determine the sensitivity, specificity, diagnostic accuracy, and AUC of these parameters for sepsis detection.
- To correlate changes in these biomarkers with sepsis severity and treatment response.
Main Methods:
- A cross-sectional study involving 1076 adult sepsis patients admitted to the ICU.
- Collected baseline and serial measurements (days 0, 3, 7) of IPF, IRF, IGP, alongside other clinical and laboratory parameters (WBC, CRP, SOFA score).
- Statistical analysis using R software to compute sensitivity, specificity, diagnostic accuracy, and AUC for IPF, IRF, and IGP.
Main Results:
- IPF, IRF, and IGP levels were significantly higher on admission and decreased by day 7 (p < 0.001), correlating with clinical improvement.
- IPF demonstrated the highest diagnostic performance with sensitivity (0.933), specificity (0.959), accuracy (0.954), and AUC (0.998).
- IRF also showed strong performance (sensitivity 0.858, specificity 0.919, accuracy 0.905, AUC 0.952), while IGP had moderate results.
Conclusions:
- IPF, IRF, and IGP are effective biomarkers for early sepsis diagnosis, reflecting bone marrow activity.
- Decreased levels of these immature cell fractions by day 7 indicate positive sepsis treatment response.
- High sensitivity, specificity, and AUC values support the clinical application of IPF and IRF in sepsis management.
Background And Objectives:
Sepsis-related mortality is a global health concern. It mandates early and accurate diagnosis of sepsis. Recently, the immature platelet fraction (IPF), immature reticulocyte fraction (IRF), and immature granulocyte percentage (IGP) have been evaluated as potential biomarkers for early sepsis detection. Hence, we conducted this study to evaluate IPF, IRF, and IGP of sepsis patients. We also evaluated the diagnostic accuracy and area under the curve (AUC) of these parameters.
Methods:
This cross-sectional study was conducted from March 2023 to February 2025 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. We included adult patients with sepsis admitted to the KIMS medicine ICU during the study period. We recorded the following parameters assessed just after hospital admission: hemoglobin, white blood cell count (WBC), platelet count, IPF, IRF, IGP, procalcitonin, C-reactive protein (CRP), and Sequential Organ Failure Assessment (SOFA) score. All these parameters were reassessed on days 3 and 7. We then computed the sensitivity, specificity, and diagnostic accuracy of IPF, IRF, and IGP. R software (version 4.5.2, Vienna, Austria) was used for statistical analysis.
Results:
We analyzed 1076 sepsis patients in this study. The study population had a median age of 58.0 (46.8-64.0) years. Of them, 608 (56.5%) were male participants. On day 0, the median values of IPF, IRF, and IGP of the study population were 4.98% (4.61-5.60), 2.79% (2.48-3.19), and 3.02% (2.40-3.95), respectively. The changes in these three parameters on day 7 were statistically significant (p < 0.001). The sensitivity values for IPF, IRF, and IGP were 0.933, 0.858, and 0.671, respectively. The specificity values for IPF, IRF, and IGP were 0.959, 0.919, and 0.708, respectively. The diagnostic accuracy values for IPF, IRF, and IGP were 0.954, 0.905, and 0.700, respectively. The AUC values for IPF, IRF, and IGP were 0.998 (0.997-0.999), 0.952 (0.934-0.971), and 0.708 (0.654-0.761), respectively.
Conclusion:
The IPF, IRF, and IGP values at ICU admission reduced after seven days, indicating improvement in sepsis. Similarly, the SOFA scores were also reduced on day 7. The high values of IRF and IPF during admission implied increased erythropoietic and thrombopoietic actions in bone marrow. The surges in immature cell types indicated the initial stages of infection and the immunocompetent state of the patients. The high sensitivity, specificity, diagnostic accuracy, and AUC values of IPF, IRF, and IGP supported their potential as biomarkers for sepsis.
