Eosinopenia as a marker of sepsis and mortality in critically ill patients

Introduction

The idea of using the eosinophil count (EC) as a diagnostic marker for clarifying the nature of systemic inflammatory response syndrome (SIRS) belongs to K Abidi, who showed that EC could be used as a diagnostic criterion of sepsis. There are no published data to define the role of dynamic control of EC in the process of intensive therapy as a prognostic marker and indicator of severity condition in critically ill patients. The aim was to determine the informative value of EC in the development of SIRS as a biomarker of sepsis and indicator of the severity condition and prognosis of outcome in the pathological process.

Methods

A total of 143 patients were enrolled in this study who were admitted to the ICU and had SIRS. All patients were divided into a septic group - patients with community-acquired pneumonia, complicated by sepsis - and two SIRS groups of noninfectious genesis - patients who had an acute cerebrovascular accident (CVA) and an acute myocardial infarction (AMI). The absolute EC was measured at admission and in the dynamics on days 3 to 5 of stay.

Results

The median EC was 75 cells/mm³ in septic patients on admission, which was significantly lower than in patients with CVA (120 cells/mm³) and AMI (130 cells/mm³). Comparison of EC in septic patients between survivors and those who died showed significant differences (Table 1). Receiver operating characteristic (ROC) analysis determined a value less than 80 cells/mm³ as the optimal diagnostic cutoffvalue with a high level of confidence in the comparison of septic and noninfectious groups. Area under the ROC curves was 0.94, sensitivity of 80.8%, specificity of 95.6%, P < 0.0001. There was a significant increase of EC in survivors, while the EC did not change significantly among those who died in the dynamics. ROC analysis determined the cutoff values of EC, which indicated a high risk of an adverse outcome in septic patients (Table 2).

Table 1 Dynamics of eosinophil count depending on outcome in groups.

Table 2 Informational value of eosinophil count in assessment of disease outcome.

Conclusion

EC may be an additional diagnostic marker which characterizes the nature of SIRS. Eosinopenia associated with prognosis of outcome in critical conditions.