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Cell population data for early detection of sepsis in patients with suspected infection in the emergency department

  • Marta Cancella De Abreu ORCID logo EMAIL logo , Caren Brumpt , Timothé Sala , Nathalie Oueidat , Martin Larsen and Pierre Hausfater
Published/Copyright: April 11, 2025
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 8

Abstract

Objectives

Traditional biomarkers used for sepsis diagnosis have limited sensitivity and specificity and, so far, are not recommended for sepsis diagnosis. We aimed to evaluate diagnostic accuracy of XN-9000® hematology analyzer derived cell population data (CPD) for sepsis.

Methods

We conducted a cross-sectional cohort study on patients admitted to an emergency department (ED) with a suspicion of infection, having a complete blood count with differential (CBC-Diff). CBC-Diff were performed on XN-9000® analyzer (Sysmex, Kobe, Japan). CPD were measured routinely for each CBC-Diff ordered by ED physician. They include: neutrophils-related - Neut-GI and Neut-RI; monocytes-related - Mono-X, Mono-Z, Re-Mono and Mono-Y; IG referring to immature granulocytes; and lymphocytes-related - As-lymp and Re-lymp. Intensive care infection (ICIS) and neutrophile and monocyte (NEMO) scores were calculated using several CPD parameters. Diagnostic performance of each biomarker was computed together with receiver operating characteristic curves for sepsis diagnosis (according to Sepsis-3 definition).

Results

A total of 1,155 patients with a suspicion of infection were included and 230 had sepsis. Median age was 64 years and 49 % were female. Except for lymphocyte count with an area under the receiver operating characteristic (AUROC) of 0.67 (95 % confidential interval 0.63–0.70), the other CPD exhibited modest performances with AUROC under 0.65. The ICIS and NEMO scores had a modest performance with AUROC of 0.56 (0.52–0.61) and 0.55 (0.51–0.59) respectively.

Conclusions

None of the biomarkers and scores tested demonstrated sufficient diagnostic accuracy to be recommended for routine sepsis screening in the ED.

Keywords: sepsis; cell population data; diagnosis; biomarkers; complete blood count with differential; emergency department
Corresponding author: Marta Cancella De Abreu, Emergency Department, APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France; and GRC-14 BIOSFAST, CIMI, UMR 1135, Sorbonne Université, Paris, France, E-mail:

Funding source: Sysmex Corporation

Acknowledgments

Enfel HOUAS and Ilaria CHERUBINI (our CRA) for their enormous help on data collection and quality control performance daily; Laura WAKSELMAN, Naima ZEMIRLI and Juliette BLONDY (Unité de Recherche Clinique (URC), Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix), for helping with ethical approval; Jeremy CORRIGER, Sorbonne University, for helping in discussion of statistical analysis.

  1. Research ethics: Infectious Ethic Committee (CER-MIT) (in Paris, France) approved the study.

  2. Informed consent: According to the French law, as there were no modifications in standard of care, it was exempted from informed consent. At ED arrival, patients were informed on possible inclusion to this study, in case of sepsis.

  3. Author contributions: MCA – Conceptualization, Methodology, Data review and Management, Formal Analysis, Investigation, Writing TS – Patient’s screening CB – Methodology, Formal Analysis. NO – Methodology, Formal Analysis. ML – Methodology, Statistical Analysis supervision. PH – Conceptualization, Methodology, Funding Acquisition, Supervision, patient’s screening, writing review and editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: Sysmex participated in funding the ED clinical research assistants for data collection. Sysmex provided the reagents for measuring CPD free of charge. Sysmex did not had a role in the conceptualization, design, data collection and analysis neither on decision to publish nor on preparation of the manuscript.

  7. Data availability: Not applicable.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0180).

Received: 2025-02-14
Accepted: 2025-03-24
Published Online: 2025-04-11
Published in Print: 2025-07-28

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2025-0180
Keywords for this article
sepsis; cell population data; diagnosis; biomarkers; complete blood count with differential; emergency department

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Setting analytical performance specification by simulation (Milan model 1b)
  4. Reviews
  5. Unveiling the power of R: a comprehensive perspective for laboratory medicine data analysis
  6. Clostebol detection after transdermal and transmucosal contact. A systematic review
  7. Opinion Papers
  8. A value-based score for clinical laboratories: promoting the work of the new EFLM committee
  9. Digital metrology in laboratory medicine: a call for bringing order to chaos to facilitate precision diagnostics
  10. Perspectives
  11. Supporting prioritization efforts of higher-order reference providers using evidence from the Joint Committee for Traceability in Laboratory Medicine database
  12. Clinical vs. statistical significance: considerations for clinical laboratories
  13. Genetics and Molecular Diagnostics
  14. Reliable detection of sex chromosome abnormalities by quantitative fluorescence polymerase chain reaction
  15. Targeted proteomics of serum IGF-I, -II, IGFBP-2, -3, -4, -5, -6 and ALS
  16. Candidate Reference Measurement Procedures and Materials
  17. Liquid chromatography tandem mass spectrometry (LC-MS/MS) candidate reference measurement procedure for urine albumin
  18. General Clinical Chemistry and Laboratory Medicine
  19. Patient risk management in laboratory medicine: an international survey to assess the severity of harm associated with erroneous reported results
  20. Exploring the extent of post-analytical errors, with a focus on transcription errors – an intervention within the VIPVIZA study
  21. A survey on measurement and reporting of total testosterone, sex hormone-binding globulin and free testosterone in clinical laboratories in Europe
  22. Quality indicators in laboratory medicine: a 2020–2023 experience in a Chinese province
  23. Impact of delayed centrifugation on the stability of 32 biochemical analytes in blood samples collected in serum gel tubes and stored at room temperature
  24. Concordance between the updated Elecsys cerebrospinal fluid immunoassays and amyloid positron emission tomography for Alzheimer’s disease assessment: findings from the Apollo study
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  26. Use of the BIOGROUP® French laboratories database to conduct CKD observational studies: a pilot EPI-CKD1 study
  27. Reference Values and Biological Variations
  28. Consensus instability equations for routine coagulation tests
  29. Hematology and Coagulation
  30. Flow-cytometric lymphocyte subsets enumeration: comparison of single/dual-platform method in clinical laboratory with dual-platform extended PanLeucogating method in reference laboratory
  31. Cardiovascular Diseases
  32. Novel Mindray high sensitivity cardiac troponin I assay for single sample and 0/2-hour rule out of myocardial infarction: MERITnI study
  33. Infectious Diseases
  34. Cell population data for early detection of sepsis in patients with suspected infection in the emergency department
  35. Letters to the Editor
  36. Lab Error Finder: A call for collaboration
  37. Cascading referencing of terms and definitions
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