Introduction: Sepsis is a life-threatening condition. Nowadays, hospitals rely on laboratory parameters like CRP and procalcitonin to detect sepsis. There is a need to evaluate and validate more accurate and early predictors of sepsis in critically ill patients. We analyzed volume, conductivity, and scatter (VCS) parameters of leukocytes in sepsis patients and compared them with the control group with no illness.
Materials and methods: It was a prospective case-control study. A total of 80 patients were studied with 40 sepsis cases and 40 controls. Peripheral smear examination was done in all the cases. Other parameters, such as WBC count, neutrophil%, absolute neutrophil count (ANC), – High-sensitive C-reactive protein (hs-CRP), procalcitonin, and blood cultures were analyzed. We took the data of the patients from medical records and correlated it with other tests. Complete blood picture reports were generated by the Beckman Coulter LH series (LH 750 and 780). VCS parameters for neutrophils, lymphocytes and monocytes were compared between both groups. The results were analyzed using SPSS software (16.0 version)
Results: The age group was 20–85 years with male predominance. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group when compared with the control group. The mean neutrophil conductivity and scatter was lower in the sepsis group and comparatively higher in the control group but it was insignificant. The mean neutrophil volume values were higher in the sepsis group even with low total leukocyte count (TLC) when the patient had sepsis. There is no change in the mean lymphocyte VCS parameter and mean monocyte conductivity, scatter in both the groups.
Conclusion: The mean neutrophil volume and MMV are found to be good sensitive markers in the prediction of sepsis. Even when TLC is on the lower side in patients with sepsis, these parameters predict sepsis accurately. This helps clinicians to assess sepsis in patients at an early stage and has an important practical implication.
Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent J-L. Sepsis and septic shock. Nature Reviews Diseases Primers 2016;2:16045. DOI: https://doi.org/10.1038/nrdp.2016.45.
Gleckman R, Hibet D. Afebrile bacteremia. A phenomenon in geriatric patients. JAMA 1982;248(12):1478–1481. DOI:10.1001/jama.1982.03330120036026.
Castle SC, Norman DC, Yeh M, Miller D, Yoshikawa TT. Fever response in elderly nursing home residents: are the older truly colder? J Am Geriatr Soc 1991;39:853–857. DOI: 10.1111/j.1532-5415.1991.tb04450.x.
Lee AJ, Kim S-G. Mean cell volumes of neutrophils and monocytes are promising markers of sepsis in elderly patients. Blood Res 2013;48(3):193–197. DOI: 10.5045/br.2013.48.3.193.
Krause JR. Automated differentials in the hematology laboratory. Am J Clin Pathol 1990;93(4 suppl 1):S11–S16. PMID: 2180276.
Chaves F, Tierno B, Xu D. Quantitative determination of neutrophil VCS parameters by the coulter automated hematology analyzer, Am J Clin Pathol 2005;14:440–444. DOI: 10.1309/LLF7-5W0F-WQQ8-TCC5.
Kannan A, Selvam P. Potential of using VCS parameters of neutrophils and monocytes as an early diagnostic tool in acute bacterial infections. Nat J Lab Med 2017;6(2):P038–043. DOI: 10.7860/NJLM/2017/27964:2222.
Richardson-Jones A. An automated hematology instrument for comprehensive WBC, RBC, and platelet analysis. Am Clini Lab 1990;9:18–22. PMID: 10149057.
Chaves F, Tierno B, Xu D. Neutrophil volume distribution width: a new automated hematologic parameter for acute infection. Arch Pathol Lab Med 2006;48(3):193–197. DOI: https://doi.org/10.5858/2006-130-378-NVDWAN.
Purohit AHL, Kumar P, Sharma S, Kapil A, Gupta A, Mukhopadhyay AK. Volume, conductivity and scatter parameters as diagnostic aid to bacterial sepsis: A tertiary care experience. Indian J Pathol Microbiol 2015;58(4):459–463. DOI: 10.4103/0377-4929.168853.
Suresh PK, Minal J, Rao PS, Ballal K, Sridevi HB, Padyana M. Volume conductivity and scatter parameters as an indicator of acute bacterial infections by the automated haematology analyser. J Clin Diagnostic Res 2016;10(1):01–03. DOI: 10.7860/JCDR/2016/14059.7009.
Bagdasaryan R, Zhou Z, Tierno B, Rosenman D, Xu D. Neutrophil VCS parameters are superior indicators for acute infections. Lab Haematol 2007;13(1):12–16. DOI: 10.1532/LH96.06048.
Zhu Y, Cao X, Chen Y, Zhang K, Wang Y, Yuan K, et al. Neutrophil cell population data: useful indicators for postsurgical bacterial infection. Int J Lab Hem 2012;344(3):295–299. DOI: 10.1111/j.1751-553X.2011.01394.x.
Celik IH, Demirel G, Aksoy HT, Erdeve O, Tuncer E, Biyikli Z, et al. Automated determination of neutrophil VCS parameters in diagnosis and treatment efficacy of neonatal sepsis. Pediatr Res 2012;71(1):121–125. DOI: 10.1038/pr.2011.16.
Villaneuva III E, Almirol BJ. The accuracy of MNV relative to blood culture for the diagnosis of sepsis: A meta-analysis, Philippine J Pathol 2017;2(1)18. DOI:10.21141/PJP.2017.004.
Nesargi P, Niranjan HS, Bandiya P, Benakappa N, et al. Neutrophil Volume, conductivity and scatter (VCS) as a screening tool in neonatal sepsis. Sci Rep 2020;10:4457. DOI: 10.1038/s41598-020-61434-z.
Mardi D, Fwity B, Lobmann R, Ambrosch A. Mean cell volume of neutrophils and monocytes compared with C-reactive protein, interleukin-6 and white blood cell count for prediction of sepsis and nonsystemic bacterial infections. Int J Lab Hem 2010;32(4):410–418. DOI: 10.1111/j.1751-553X.2009.01202.x.
Abiramalatha T. Utility of neutrophil volume conductivity scatter (VCS) parameter changes as sepsis screen in neonates. J Perinatol 2016;1–6.
Arora P, Gupta PK, Lingaiah R, Mukhopadyay AK. Volume, conductivity and scatter parameters of leukocytes as early markers of sepsis and treatment response. Journal of Lab Physicians 2019;11:29–33. DOI: 10.4103/JLP.JLP_102_18.