IMPAIRED NEUTROPHIL ADHERENCE AS AN EARLY MARKER OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND SEVERE SEPSIS

Study objective: To determine whether neutrophil adherence was altered in the presence of systemic inflammatory response syndrome (SIRS) and infection or severe sepsis. Methods: 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 p hlebotomy was performed in the ED and 12 and 24 hours into the hospita l stay. We used an adherence assay that involves adding 1-mL aliquots of heparinized blood to pipettes packed with nylon. Cell count and dif ferential on the eluates and a control tube were carried out to determ ine the percentage of adhering neutrophils. We reviewed charts for par ameters of clinical progression. Results: Adherence values among patie nts with SIRS and severe sepsis were 27% +/- 17% (n = 19) and 13% +/- 16% (n = 4), respectively, significantly less than mean adherence in n ormal controls (47% +/- 10%; P = .0006 and .0007, ANOVA). Adherence am ong patients with severe sepsis and those who clinically progressed we re not significantly different from that in all SIRS cases. Serial val ues did not differ from initial values. Conclusion: Neutrophil adheren ce was significantly decreased in patients with SIRS and severe sepsis compared with that in normal controls. A larger study enrolling conse cutive SIRS subjects at risk for severe sepsis may demonstrate whether this assay could be useful in managing sepsis in the ED.