Impaired neutrophil adherence as an early marker of systemic inflammatory response syndrome and severe sepsis

To determine whether neutrophil adherence was altered in the presence of systemic inflammatory response syndrome (SIRS) and infection or severe sepsis.

We conducted a prospective study of a convenience sample of adults presenting to an academic urban ED to be admitted with SIRS and infection or with severe sepsis. Serial phlebotomy was performed in the ED and 12 and 24 hours into the hospital stay. We used an adherence assay that involves adding 1-mL aliquots of heparinized blood to pipettes packed with nylon. Cell count and differential on the eluates and a control tube were carried out to determine the percentage of adhering neutrophils. We reviewed charts for parameters of clinical progression.

Adherence values among patients with SIRS and severe sepsis were 27% +/- 17% (n = 19) and 13% +/- 16% (n = 4), respectively, significantly less than mean adherence in normal controls (47% +/- 10%; P = .0006 and .0007, ANOVA). Adherence among patients with severe sepsis and those who clinically progressed were not significantly different from that in all SIRS cases. Serial values did not differ from initial values.

Neutrophil adherence was significantly decreased in patients with SIRS and severe sepsis compared with that in normal controls. A larger study enrolling consecutive SIRS subject at risk for severe sepsis may demonstrate whether this assay could be useful in managing sepsis in the ED.