28-day Mortality Of Sepsis Patients Research Articles

Prognosis and rescue therapy for sepsis-related severe thrombocytopenia in critically ill patients

Sepsis is the most common critical disease with high mortality in intensive care unit. Platelet count (PC) frequently altered in sepsis patients and implicated in the pathogenesis of multi-organ failure. It is also worth mentioning that thrombocytopenia was closely associated with poor outcomes in sepsis patients. However, whether drug intervention aimed at correcting thrombocytopenia would improve the prognosis of sepsis patients and which kind of sepsis patients could benefit from this therapy is still unclear. This study aims to explore the effect of severe thrombocytopenia on the prognosis of sepsis and the impact of a platelet-elevating drug (recombinant human thrombopoietin, rhTPO) for these sepsis patients. In this study, we included 249 sepsis patients diagnosed by sepsis 3.0, and these patients were classified into the three groups based on PC: normal (PC ≥ 100 × 109/L), mild-moderate thrombocytopenia (50 × 109/L ≤ PC < 100 × 109/L), and severe thrombocytopenia (PC < 50 × 109/L). We found that patients with severe thrombocytopenia had more blood transfusion, shorter days free from organ support, and worse outcomes as compared with the normal group. However, there was no significant difference between normal and mild-moderate thrombocytopenia groups. Furthermore, a subgroup analysis showed that rescue therapy with rhTPO could rapidly lead to a recovery of the PC, prolong days free from organ support, increase survival days, and reduce the 28-day mortality in sepsis patients with severe thrombocytopenia. These results suggested that sepsis patients with severe thrombocytopenia, not mild-moderate thrombocytopenia, had a poorer prognosis. RhTPO, probably as effective rescue therapy, could quickly recover PC and improve the prognosis in these sepsis patients.

Association between plasma adiponectin levels and left ventricular systolic dysfunction in sepsis patients.

As a well-known cardioprotective factor, the relevance of adiponectin (APN) to heart function following sepsis remains largely unknown. The present study evaluated the effects of plasma APN levels on heart function and 28-day mortality in sepsis patients. This was a prospective study that was performed with 98 patients with sepsis and 32 controls. Left ventricular systolic dysfunction (LVSD) was defined as a left ventricular ejection fraction (LVEF)≤45% based on echocardiography. The effects of APN on the development of sepsis-related LVSD and prediction of 28-day mortality were evaluated. Plasma APN levels significantly decreased in sepsis patients compared with controls, with rising severity of illness, and positively correlated with the LVEF and stroke volume index. Sepsis patients with LVSD had lower APN levels than patients without LVSD. According to the receiver operating characteristic curve, plasma APN levels had the comparable value in prediction of LVSD incidence than those conditional factors, including brain natriuretic peptide (BNP) and highly sensitive cardiac troponin T (hsTnT). Twenty-three of the 98 sepsis patients (23.47%) died at 28days. Adiponectin levels were an independent predictive factor for 28-day mortality. Low APN levels were associated with the incidence of LVSD and 28-day mortality in sepsis patients. Adiponectin may be a novel factor that may be useful for the diagnosis of LVSD.

Decreased microRNA 103 and microRNA 107 predict increased risks of acute respiratory distress syndrome and 28-day mortality in sepsis patients.

We aimed to investigate the predictive value of microRNA 103 (MIR103) and microRNA 107 (MIR107) for acute respiratory distress syndrome (ARDS) risk, as well as their correlations with overall disease severity and prognosis in sepsis patients.Plasma samples were collected from 196 sepsis patients within 24 hours after enrollment and from 196 healthy individuals (as healthy controls (HCs)) at enrollment. Plasma MIR103 and MIR107 were detected by reverse transcription-quantitative polymerase chain reaction.MIR103 and MIR107 were both decreased in ARDS sepsis patients and non-ARDS sepsis patients compared to HCs, and were reduced in ARDS sepsis patients than non-ARDS sepsis patients. Decreased MIR103 (area under curve (AUC): 0.727, 95% confidence interval (CI): 0.619–0.835) and MIR107 (AUC: 0.694, 95% CI: 0.577–0.811) predicted increased ARDS risk in sepsis patients. Meanwhile, MIR103 and MIR107 were negatively correlated with acute pathologic and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, serum creatinine, C-reactive protein, tumor necrosis factor, interleukin 1β, interleukin 6 and interleukin 8, while positively correlated with albumin in sepsis patients. For prognosis, 28-day mortality was increased in ARDS sepsis patients compared to non-ARDS sepsis patients. Finally, MIR103 and MIR107 were reduced in deaths than survivors of sepsis patients, and decreased MIR103 (AUC: 0.704, 95% CI: 0.626–0.782) as well as MIR107 (AUC: 0.649, 95% CI: 0.569–0.729) predicted increased 28-day mortality risk in sepsis patients.MiR-103 and MIR107 were predictive biomarkers for risks of ARDS and 28-day mortality in sepsis patients, which might improve the management of sepsis.

Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients.

BackgroundSepsis-induced cardiomyopathy (SIC) occurs frequently in critically ill patients, but the clinical features and prognostic impact of SIC on sepsis outcome remain controversial. Here, we investigated the predictors and outcomes of SIC.MethodsPatients admitted to a single medical intensive care unit from June 2016 to September 2017 were retrospectively reviewed. SIC was diagnosed by ejection fraction (EF) <50% and ≥10% decrease in baseline EF that recovered within 2 weeks.ResultsIn total, 342 patients with sepsis met the inclusion criteria, and 49 patients (14.3%) were diagnosed with SIC; the latter were compared with 259 patients whose EF was not deteriorated by sepsis (non-SIC). Low systolic blood pressure and increased left ventricular end-diastolic diameter (LVEDD) were identified as predictors of SIC. SIC and non-SIC patients did not differ significantly in terms of 28-day all-cause mortality (24.5% vs. 26.3%, P=0.936). Acute Physiology and Chronic Health Evaluation II (APACHE II; hazard ratio [HR], 1.10; 95% confidential interval [CI], 1.02 to 1.18; P=0.009) and delta neutrophil index (DNI; HR, 1.02; 95% CI, 1.00 to 1.08; P=0.026) were independent risk factors for 28-day mortality with SIC. DNI, APACHE II, and lactate were identified as risk factors for 28-day mortality in sepsis patients as a whole.ConclusionsSIC was not associated with increased mortality compared to non-SIC. Low systolic blood pressure and increased LVEDD were predictors of SIC. High APACHE II score and elevated DNI, which reflect sepsis severity, predict 28-day all-cause mortality.

Clinical predictive value of short-term dynamic changes in platelet counts for prognosis of sepsis patients in intensive care unit: a retrospective cohort study in adults

To explore clinical predictive value of short-term dynamic changes in platelet counts (PLT) for prognosis of sepsis patients in intensive care unit (ICU). A retrospective cohort study was conducted. The patients aging 18 to 80 years old who were diagnosed by Sepsis-3 admitted to ICU of South Branch of Shanghai General Hospital from November 2015 to October 2018 were enrolled. According to whether the patients died within 28 days, they were divided into death and survival groups. General information and clinical baseline data [including disease severity score, infection biomarkers, PLT and organ function parameters (cardiac, liver, kidney, coagulation) and inflammatory cytokines] between the two groups were compared. Based on clinical indicators which had statistically significance, receiver operating characteristic (ROC) curve was drawn to predict the prognosis of the patients within 28 days. Then, risk factors of 28-day mortality of sepsis patients in ICU were screened by univariate and multivariate Logistic regression analysis. On the basis of multivariate Logistic regression analysis results, a multiparameter model was built, and the ROC curve was drawn to predict its prognosis within 28 days. A total of 220 sepsis patients were enrolled. Among them, 61 patients died and 159 patients survived within 28 days with a 28-day mortality of 27.7%. Compared with the survival group, the patients in the death group were senior in age, more likely to suffer from chronic cardiovascular, chronic kidney and immune system disease, had higher scores in acute physiologic and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, disseminated intravascular coagulation (DIC) score and less PLT on the 1st and 7th day, sustained a higher incidence of persistent thrombocytopenia (PLT were all < 100×109/L in the first week after ICU admission) or acquired thrombocytopenia (PLT ≥ 100×109/L on the day of ICU admission, but dropped over 50% during the first week after ICU admission), were subjected to higher procalcitonin (PCT) and interleukin-6 (IL-6) levels and endured worse organ function (cardiac, kidney, coagulation) with statistically significant differences. However, there was no significant difference in gender, disease type, infection sites, pathogens or liver function. The ROC curve analysis for the 28-day prognosis of sepsis illustrated that the three disease severity scores could predict the 28-day prognosis of sepsis in ICU, and the area under ROC curve (AUC) of SOFA score was the highest (AUC = 0.878). The AUC of PLT on the 7th day was higher than that on the 1st day (AUC: 0.862 vs. 0.674), and the AUC of other clinical indicators were all < 0.8. Univariate and multivariate Logistic regression analysis showed that SOFA score [odds ratio (OR) = 1.423, 95% confidence interval (95%CI) was 1.089-1.859, P = 0.010], troponin I (TnI; OR = 2.056, 95%CI was 1.057-3.999, P = 0.034), and persistent or acquired thrombocytopenia (OR = 13.028, 95%CI was 4.033-42.090, P < 0.001) were three independent risk factors for 28-day mortality of the sepsis patients in ICU. Based on the multivariate Logistic regression analysis results, a multiparameter model was built with SOFA score, TnI and persistent or acquired thrombocytopenia, which showed a AUC of 0.926 to predict the 28-day mortality of sepsis patients in ICU. When the optimum cut-off value was 0.398 in the model, the sensitivity was 76.8%, and the specificity was 92.8%. Persistent or acquired thrombocytopenia within the first week of hospitalization proves to have a relatively momentous clinical predictive value for prognosis of sepsis patients in ICU. Clinical intervention focusing on thrombocytopenia may become a new potential therapy for these sepsis patients.

Plasma miR-125a and miR-125b in sepsis: Correlation with disease risk, inflammation, severity, and prognosis.

ObjectiveThis study aimed to explore the predictive value of microRNA (miR)‐125a and miR‐125b for sepsis risk, and their correlations with inflammation, disease severity, and 28‐day mortality in sepsis patients.MethodsTotally, 150 sepsis patients and 150 healthy controls (HCs) were enrolled. Plasma samples were separated from blood samples obtained from sepsis patients and HCs to detect miR‐125a and miR‐125b expressions by real‐time quantitative polymerase chain reaction. Besides, the 28‐day mortality of sepsis patients was assessed. MiR‐125a and miR‐125b expressions were elevated in sepsis patients compared with HCs, and further receiver operating characteristics (ROC) curve analysis displayed that miR‐125a (area under the curve (AUC): 0.749, 95% CI: 0.695‐0.803) and miR‐125b (AUC: 0.839, 95% CI: 0.795‐0.882) could predict sepsis risk. As for inflammation, no correlation of miR‐125a with C‐reactive protein (CRP), tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐6, IL‐17, and IL‐23 was observed in sepsis patients, while miR‐125b was positively associated with CRP, TNF‐α, IL‐6, IL‐17, and IL‐23. Regarding disease severity, miR‐125a and miR‐125b were positively correlated with acute physiology and chronic health care evaluation II and sequential organ failure assessment score in sepsis patients. Besides, ROC curve analysis exhibited that miR‐125a failed to predict 28‐day mortality risk (AUC: 0.588, 95% CI: 0.491‐0.685) in sepsis patients, while miR‐125b had a potential value in predicting elevated 28‐day mortality risk (AUC: 0.699, 95% CI: 0.603‐0.795).ConclusionBoth miR‐125a and miR‐125b predict sepsis risk, while only miR‐125b exhibits the potency for disease management and prognosis prediction in sepsis patients.

The predictive value of microRNA‐21 for sepsis risk and its correlation with disease severity, systemic inflammation, and 28‐day mortality in sepsis patients

BackgroundThis study aimed to investigate the value of microRNA (miR)‐21 for predicting sepsis risk and its correlation with inflammation, disease severity as well as 28‐day mortality in sepsis patients.MethodsTotally, 219 sepsis patients and 219 healthy controls (HCs) were recruited. Plasma samples were obtained from sepsis patients within 24 hours after admission and from HCs at the enrollment to detect miR‐21 expressions by real‐time quantitative polymerase chain reaction. Besides, the clinical characteristics of sepsis patients were recorded and the 28‐day mortality of sepsis patients was evaluated.ResultsMiR‐21 expression was decreased in sepsis patients compared with HCs, and further receiver operating characteristic (ROC) curve analysis revealed that miR‐21 was of a good value in predicting sepsis risk (area under the curve [AUC]: 0.801, 95% CI: 0.758‐0.844). Besides, miR‐21 expression was negatively associated with acute pathologic and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) score in sepsis patients. Furthermore, miR‐21 expression was negatively correlated with serum creatinine, C‐reactive protein, tumor necrosis factor‐α, interleukin (IL)‐1β, IL‐6, and IL‐17, while positively correlated with albumin in sepsis patients. However, there was no correlation of miR‐21 expression with white blood cell, smoke, or comorbidities in sepsis patients. Additionally, ROC curve analysis displayed that miR‐21 exhibited a poor predictive value for 28‐day mortality risk in sepsis patients (AUC: 0.588, 95% CI: 0.505‐0.672).ConclusionMiR‐21 might serve as a potential biomarker for the development and progression of sepsis, while not for prognosis prediction in sepsis patients.

Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

PurposeSepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis. MethodsThe study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38°C or lower than 36°C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores. ResultsAmong the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788–0.963) as compared with 0.75 (0.634–0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%. ConclusionSPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

Inflammatory anemia-associated parameters are related to 28-day mortality in patients with sepsis admitted to the ICU: a preliminary observational study

BackgroundAnemia is one of the most common complications of sepsis. Sepsis-related anemia is associated mainly with inflammation. We aimed to observe the changes in the inflammatory anemia-associated parameters of patients with sepsis in the early stage of intensive care unit (ICU) admission and to evaluate their association with 28-day mortality.MethodsA total of 198 patients with sepsis were divided into survivor (n = 110) and non-survivor (n = 88) groups on the basis of 28-day survival. Healthy volunteers (n = 20) were enrolled as a control group. Plasma levels of iron, ferritin, erythropoietin (EPO), soluble transferrin receptor (sTfR), hepcidin, interleukin-6 (IL-6), hemoglobin and the red blood cell distribution width (RDW) were measured on days 1, 3 and 7 of ICU admission. Clinical data and laboratory findings were collected, and the Sequential Organ Failure Assessment (SOFA) score was calculated.ResultsPatients with sepsis showed significant decreases in hemoglobin, plasma iron and sTfR/log ferritin and significant increases in plasma EPO, sTfR, hepcidin, ferritin and IL-6 on days 1, 3 and 7 of ICU admission compared with healthy volunteers. Hemoglobin was correlated negatively with plasma IL-6 and hepcidin. In patients with sepsis, non-survivors had significantly lower plasma iron, EPO and sTfR/log ferritin, but higher plasma hepcidin, ferritin and IL-6 than survivors on days 1, 3 and 7 of ICU admission. Plasma EPO, hepcidin, ferritin, IL-6, sTfR/log ferritin, the RDW and SOFA score were associated significantly with 28-day mortality but to a varying extent. In particular, in predicting 28-day mortality, plasma hepcidin had an area under the receiver operating curve of 0.808 and 87.3% specificity, which was the highest among the inflammatory anemia-associated parameters tested.ConclusionsInflammatory anemia-associated parameters changed significantly in patients with sepsis in the first week of ICU admission. Plasma EPO, hepcidin, ferritin, IL-6, sTfR/log ferritin, the RDW and SOFA score were associated significantly with 28-day mortality. Plasma hepcidin might have a superior predictive value, with high specificity, compared with other inflammatory anemia-associated parameters for 28-day mortality of sepsis patients in the ICU.

Elevated circulating lnc-ANRIL/miR-125a axis level predicts higher risk, more severe disease condition, and worse prognosis of sepsis.

This study aimed to investigate the correlation of lnc-ANRIL/miR-125a axis with risk, severity, inflammation, and prognosis of sepsis. A hundred and twenty-six sepsis patients and 125 healthy controls were recruited, and then, blood samples were collected, and plasma was separated for lnc-ANRIL, miR-125a, lnc-ANRIL/miR-125a axis, and inflammatory cytokine level detections. In addition, basic characteristics, 28-day mortality, and accumulating survival of sepsis patients were recorded. Plasma lnc-ANRIL expression was increased, miR-125a expression was decreased, and lnc-ANRIL/miR-125a axis level was elevated in sepsis patients compared with healthy controls, and all of them had good value for predicting sepsis risk with AUCs of 0.800, 0.817, and 0.843, respectively. Lnc-ANRIL and lnc-ANRIL/miR-125a axis were positively correlated with biochemical index levels including CRP and PCT levels, disease severity scale scores, and pro-inflammatory cytokine levels in sepsis patients, while miR-125a displayed the opposite trend. Lnc-ANRIL and lnc-ANRIL/miR-125a axis expressions were elevated, while miR-125a expression was declined in deaths compared with survivors, and all of them predicted 28-day mortality in sepsis patients with AUCs of 0.765, 0.745, and 0.785, respectively. Subsequently, the Kaplan-Meier analysis revealed that patients with high lnc-ANRIL, low miR-125a, and high lnc-ANRIL/miR-125a axis levels presented with worse accumulating survival. In addition, multivariate regression model analyses revealed that high plasma lnc-ANRIL/miR-125a axis was an independent predictive factor for both increased 28-day mortality and worse accumulating survival. Circulating lnc-ANRIL/miR-125a axis was upregulated and could serve as a biomarker for severity, inflammation, and prognosis in sepsis patients.

Development and validation of immune dysfunction score to predict 28-day mortality of sepsis patients.

BackgroundSepsis-induced immune dysfunction ranging from cytokines storm to immunoparalysis impacts outcomes. Monitoring immune dysfunction enables better risk stratification and mortality prediction and is mandatory before widely application of immunoadjuvant therapies. We aimed to develop and validate a scoring system according to patients’ immune dysfunction status for 28-day mortality prediction.MethodsA prospective observational study from a cohort of adult sepsis patients admitted to ICU between August 2013 and June 2016 at Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated immune dysfunction status through measurement of baseline plasma Cytokine levels, Monocyte human leukocyte-DR expression by flow cytometry, and stimulated immune response using post LPS stimulated cytokine elevation ratio. An immune dysfunction score was created for 28-day mortality prediction and was validated.ResultsA total of 151 patients were enrolled. Data of the first consecutive 106 septic patients comprised the training cohort, and of other 45 patients comprised the validation cohort. Among the 106 patients, 21 died and 85 were still alive on day 28 after ICU admission. (mortality rate, 19.8%). Independent predictive factors revealed via multivariate logistic regression analysis included segmented neutrophil-to-monocyte ratio, granulocyte-colony stimulating factor, interleukin-10, and monocyte human leukocyte antigen-antigen D–related levels, all of which were selected to construct the score, which predicted 28-day mortality with area under the curve of 0.853 and 0.789 in the training and validation cohorts, respectively.ConclusionsThe immune dysfunction scoring system developed here included plasma granulocyte-colony stimulating factor level, interleukin-10 level, serum segmented neutrophil-to-monocyte ratio, and monocyte human leukocyte antigen-antigen D–related expression appears valid and reproducible for predicting 28-day mortality.

Neutrophil Related Data Obtained From Newly Developed Automatic Hematology Analyzer Sysmex XN-2000 Can Provide Useful Informations For The Discrimination Of Sepsis Patients

Background In addition to classical biomarkers of sepsis such as C-reactive protein (CRP), lactic acid, and procalcitonin (PCT), new parameters such as immature granulocytes (IG), which can be obtained from automated hematology analyzers without any additional cost, have been recently proposed as biomarkers for the early detection of sepsis and the evaluation of its severity. Recently launched automatic hematology analyzer Sysmex XN-2000 (Sysmex, Kobe, Japan) can provide 36 routine items as well as 57 items of cell population data (CPD) which reflect detailed status of cells examined. In this study, we evaluated the clinical relevance of CPD items as a biomarker for the diagnosis of sepsis, discrimination of sepsis severity, and prediction of outcome in sepsis patients. Methods A total of 280 normal controls (NCs) and 130 patients diagnosed as bacterial sepsis were enrolled in this study. The sepsis patients were classified into uncomplicated sepsis (N=29) and complicated sepsis (N=101, defined as severe sepsis and and septic shock) depending on the sepsis severity at the time of sampling. A total of 93 items (36 routine and 53 CPD) were obtained from the Sysmex XN-2000 automatic hematology analyzer and the results were compared between NC and sepsis group at first and between uncomplicated and complicated sepsis group later. In items with significant differences between 2 groups, receiver operating characteristics (ROC) analysis was performed to evaluate discrimination power of the item between 2 groups. In addition, the results of 93 items were compared between survivors and non-survivors after 28 days from the time of sampling, and ROC analysis was also performed to compare the prediction power of the 28-day mortality of each item which showed significant differences between 2 groups. Results Among the total 93 items, a total of 21 items showed area under the curve (AUC) more than 0.900 for the discrimination of sepsis patients from NCs. These include routine items such as hematocrit (best cutoff values ≤ 37.2%, AUC 0.964), hemoglobin (≤ 11.7 g/dL AUC 0.961), IG (≥ 0.5%, AUC 0.961), CV of RDW (&gt; 13.7%, AUC 0.951), proportion of lymphocytes (≤ 18.5%, AUC 0.941) and neutrophils (&gt; 72.2%, AUC 0.914). Notably, CPD items NE-SFL (defined as the fluorescent light intensity of the neutrophil area on the WDF scattergram) and NE-WY (defined as the fluorescent light distribution width of the neutrophil area on the WDF scattergram) showed comparative AUC of 0.909 (&gt; 51.6 for NE-SFL) and 0.905 (&gt; 641.0 for NE-WY). However, for the discrimination of sepsis severity, the overall performance of all items was relatively poor and only 3 red blood cell CPD items such as RET-UPP (defined as the count in the upper area of the RET scattergram, ≤ 2.0%, AUC of 0.662), reticulocyte hemoglobin (&gt;33.2 pg, AUC of 0.633), and MacroR (defined as the macrocytic RBC ratio, &gt; 4.60%, AUC of 0.607) and only 1 granulocyte CPD item NE-SFL (&gt; 57.6, AUC of 0.603) showed AUC more than 0.600. The performance of classical sepsis biomarkers was also not satisfactory (AUC of 0.695, 0.543, and 0.537 for lactic acid, CRP, and PCT). For the prediction of 28-day mortality, the overall performance of all items was also not good and only 4 routine items such as CV of RDW (&gt; 15.4%, AUC of 0.766), platelet counts (&lt; 54,000/µL, AUC of 0.677), absolute number of neutrophils (&gt; 12,120/µL, AUC of 0.665), absolute number of reticulocytes (&gt; 2.89 x 106/µL, AUC of 0.650), and 1 CPD item RET-TNC (defined as the count in the TNC area of the RET scattergram, &gt; 125.00, AUC of 0.692) showed AUC of more than 0.650. These results were not superior compared with those from classical sepsis biomarkers (AUC of 0.712, 0.547, and 0.592 for lactic acid, CRP, and PCT). Conclusion IG%, the proportion of neutrophils, and 2 granulocytic CPD items (NE-SFL and NE-WY) could discriminate sepsis patients from normal controls when their values increase (which means neutrophil immaturity or activation). Several CPD items showed similar performance compared with lactic acid and slightly better performance than CRP and PCT for the discrimination of sepsis severity and prediction of 28-day mortality. Therefore, it can be speculated that the CPD items of neutrophil immaturity or activation can contribute partly to the discrimination of sepsis patients from NCs, but these items do not discriminate sepsis severity and predict 28-day mortality in sepsis patients as the classical sepsis biomarkers do not. Disclosures: No relevant conflicts of interest to declare.