Neutropenic sepsis is associated with distinct clinical and biological characteristics: a cohort study of severe sepsis. Issue 1 (December 2016) - Reilly, John
Abstract Background Immunocompromised patients who develop sepsis while neutropenic are at high risk for morbidity and mortality; however, it is unknown if neutropenic sepsis is associated with distinct clinical and biological characteristics. Methods We conducted a prospective cohort study of patients admitted to the medical intensive care unit of an academic medical center with severe sepsis. Patients were followed for the development of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and mortality. Plasma proteins, representing the host inflammatory response, anti-inflammatory response, and endothelial leak were measured in 30 % of subjects. Clinical characteristics and plasma protein concentrations of patients with neutropenia at enrollment were compared to patients without neutropenia. Results Of 797 subjects enrolled, 103 (13 %) were neutropenic at ICU admission. The neutropenic subjects were more often in shock, admitted from the hospital ward, had higher APACHE III scores, and more likely bacteremic. Neutropenia was an independent risk factor for AKI (RR 1.28; 95 % CI 1.04, 1.57;p = 0.03), but not ARDS (RR 0.90; 95 % CI 0.70, 1.17;p = 0.42) or 30-day mortality (RR 1.05; 95 % CI 0.85, 1.31;p = 0.65). Neutropenic subjects had higher plasma interleukin (IL)-6 (457 vs. 249 pg/ml;p = 0.03), IL-8 (581 vs. 94 pg/ml;p <0.001), and granulocyte colony-stimulating factor (G-CSF) (3624 vs. 99 pg/ml;p <0.001). Angiopoietin-2 and IL-1 receptor antagonist concentrations did not differ between groups. Conclusions Neutropenic sepsis is associated with a higher AKI risk and concentrations of inflammatory mediators IL-6, IL-8, and G-CSF relative to non-neutropenic patients. These differences may have implications for future therapies targeting neutropenic sepsis.