Analyzing neutrophil morphology, mechanics, and motility in sepsis: Options and challenges for novel bedside technologies

Objective: Alterations in neutrophil morphology (size, shape, and composition), mechanics (deformability), and motility (chemotaxis and migration) have been observed during sepsis. We combine summarizing features of neutrophil morphology, mechanics, and motility that change during sepsis with an investigation into their clinical utility as markers for sepsis through measurement with novel technologies. Data Sources: We performed an initial literature search in MEDLINE using search terms "neutrophil," "morphology," "mechanics," "dynamics," "motility," "mobility," "spreading," "polarization," "migration," and "chemotaxis." We then combined the results with "sepsis" and "septic shock." We scanned bibliographies of included articles to identify additional articles. Study Selection and Data Extraction: Final selection was done after the authors reviewed recovered articles. We included articles based on their relevance for our review topic. Data Synthesis: When compared with resting conditions, sepsis causes an increase in circulating numbers of larger, more rigid neutrophils that show diminished granularity, migration, and chemotaxis. Combined measurement of these variables could provide a more complete view on neutrophil phenotype manifestation. For that purpose, sophisticated automated hematology analyzers, microscopy, and bedside microfluidic devices provide clinically feasible, high-throughput, and cost-limiting means. Conclusions: We propose that integration of features of neutrophil morphology, mechanics, and motility with these new analytical methods can be useful as markers for diagnosis, prognosis, and monitoring of sepsis and may even contribute to basic understanding of its pathophysiology.