Rationale: Bandemia, defined as the presence of immature neutrophils in circulation, is commonly used as an early marker of systemic inflammation and infection. 1 However, its prognostic significance in sepsis, severe sepsis, and septic shock remains uncertain. 1-2 This study aimed to determine whether bandemia is associated with adverse clinical outcomes and increased intensive care unit (ICU) resource utilization among critically ill septic patients admitted from the emergency department (ED).
Methods: A retrospective analysis was conducted using de-identified data from the HCA Healthcare database. Adult patients (aged 18–90 years) admitted to the ICU at HCA Florida Aventura Hospital from the ED between May 1 and June 30, 2024, with a diagnosis of sepsis, severe sepsis, or septic shock were included. Sepsis-related diagnoses were identified using contemporary ICD-10 criteria consistent with the Sepsis-3 era.3 Exclusion criteria were absence of differential band count and comorbidities that could confound bandemia (e.g., hematologic malignancy, systemic lupus erythematosus, human immunodeficiency virus infection, recent chemotherapy, or corticosteroid use). Patients were categorized by bandemia level:
Results: Of 9,115 encounters identified, 1,315 patients met inclusion criteria, of which 41.2% had bandemia ≥10%. In-hospital mortality was slightly higher among patients with bandemia compared to those without (22.5% vs 21.0%), but the difference was not statistically significant (p=0.5198). 5 The mean ICU LOS was similar between groups (9.10 vs 9.12 days, p=0.395). [Table 1] Use of vasopressors and mechanical ventilation was more frequent among patients with bandemia (72.7% and 49.7%, respectively) compared with those without bandemia (64.3% and 42.0%). Regression analysis identified age as the only variable significantly associated with bandemia, with each additional year of age corresponding to a 0.76% increase in the odds of bandemia (p=0.0347).
Conclusions: Although bandemia was associated with increased utilization of ICU interventions, it was not independently predictive of mortality or ICU length of stay in critically ill septic patients. These findings suggest that while bandemia may reflect underlying illness severity, it has limited value as a standalone prognostic marker in sepsis