Evaluation of lactate, white blood cell count, neutrophil count, procalcitonin and immature granulocyte count as biomarkers for sepsis in emergency department patients
Abstract
Background Lactate, white blood cell (WBC) and neutrophil count, procalcitonin and immature granulocyte (IG) count were compared for the prediction of sepsis, and severe sepsis or septic shock, in patients presenting to the emergency department (ED).Methods We prospectively enrolled 501 ED patients with a sepsis panel ordered for suspicion of sepsis. WBC, neutrophil, and IG counts were measured on a Sysmex XT-2000i analyzer. Lactate was measured by i-STAT, and procalcitonin by Brahms Kryptor. We classified patients as having sepsis using a simplification of the 1992 consensus conference sepsis definitions. Patients with sepsis were further classified as having severe sepsis or septic shock using established criteria. Univariate receiver operating characteristic (ROC) analysis was performed to determine odds ratio (OR), area under the ROC curve (AUC), and sensitivity/specificity at optimal cut-off for prediction of sepsis (vs. no sepsis), and prediction of severe sepsis or septic shock (vs. no sepsis).Results There were 267 patients without sepsis; and 234 with sepsis, including 35 patients with severe sepsis or septic shock. Lactate had the highest OR (1.44, 95th% CI 1.20-1.73) for the prediction of sepsis; while WBC, neutrophil count and percent (neutrophil/WBC) had OR>1.00 (p<0.05). All biomarkers had AUC<0.70 and sensitivity and specificity <70% at the optimal cut-off. Initial lactate was the best biomarker for predicting severe sepsis or septic shock, with an odds ratio (95th% CI) of 2.70 (2.02-3.61) and AUC 0.89 (0.82-0.96).Conclusion Traditional biomarkers (lactate, WBC, neutrophil count, procalcitonin, IG) have limited utility in the prediction of sepsis.
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Lactate alone is neither sensitive nor specific enough to rule in or rule out sepsis.
“However, lactate alone is neither sensitive nor specific enough to rule-in or rule-out the diagnosis on its own.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [51]
Lactate cutoffs for an elevated level ranged from 1.6 to 2.5 mmol/L, with similar diagnostic characteristics regardless of cutoff.
“The lactate cutoffs determining an elevated level ranged from 1.6 to 2.5 mmol/L, although diagnostic characteristics were similar regardless of the cutoff.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [51]
An elevated lactate level increases and a normal lactate level decreases the likelihood of a final diagnosis of sepsis in patients with suspected sepsis.
“In summary, the presence of an elevated or normal lactate level significantly increases or decreases, respectively, the likelihood of a final diagnosis of sepsis in patients with suspected sepsis.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [51]
For lactate as a sepsis screen, sensitivities range from 66 to 83% and specificities from 80 to 85%.
“Sensitivities range from 66 to 83%, with specificities ranging from 80 to 85%.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [51]
Pooled positive and negative likelihood ratios from three studies for lactate in suspected sepsis are 4.75 and 0.29, respectively.
“Pooled positive and negative likelihood ratios from the three studies are 4.75 and 0.29, respectively.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [51]
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- Authors
- Karon, B. S., Tolan, N. V., Wockenfus, A. M., Block, D. R., Baumann, N. A., Bryant, S. C., & Clements, C. M.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Karon, Brad S.
- Venue
- Clinical Biochemistry
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 50
- Issue
- 16-17
- Pages
- 956-958
- ISSN
- 0009-9120 (ISSN-L)
- OpenAlex
- W2620340731
- Cited by
- 84
- References
- 20
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 12 · 2023: 9 · 2022: 8 · 2021: 12 · 2020: 11 · 2019: 8 · 2018: 5 · 2017: 1
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Biochemistry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sysmex America (FP00069027)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- sepsis, septic shock, severe sepsis, lactate, procalcitonin, white blood cell count, neutrophil count, biomarkers, sepsis prediction, emergency department patients
- MeSH terms
- Calcitonin, Emergency Service, Hospital, Humans, Leukocyte Count, Sensitivity and Specificity, Biomarkers, Odds Ratio, Sepsis, Lactic Acid
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