Eosinopenia as a Diagnostic Marker of Sepsis in Critically Ill Patients

Abstract

Background: sepsis refers to the presence of a serious infection that correlates with systemic and uncontrolled immune activation. Few studies had analyzed eosinophil count as a prognostic marker of outcome in patients with infection. Eosinopenia is an interesting biomarker because the eosinophil count is always measured in clinical practice and the additional costs would therefore be negligible.The aim of this wrk: this studyaimed to test the value of eosinopenia in the diagnosis of sepsis in critically ill patients admitted to ICUs. Patients and Methods: this prospective observational, randomized study was conducted on 50 adult critically ill patients who were admitted to ICU of Ahmed Maher Teaching Hospitalin the period from March 2017to July 2017. They either had sepsis on admission or not. An informed written consent was obtained from patients and/or relatives before starting this study. Inclusion criteria were patients more than 18 years old and less than 60 years that were critically ill either in sepsis or not. Exclusion criteria were patients less than 18 years old and more than 60 years old, patient or relatives who refused to be included in this study, those with hematological cancer, HIV infection, bronchial asthma and other atopic disorders like hay fever, atopic dermatitis and allergic conjunctivitis and increased levels of eosinophil count as part of any parasitic infection or trauma patients. Results: comparison between infected and non-infected studied patients was statistically significant as regard variables of SOFA score, APACHE II score at admission, TLC and Eosinophil count at admission (p-value˂0.05). There were no statistical significant differences as regard length of ICU stay (p˃0.05). Multivariate regression analysis showed statistically significant differences and was independent predictors for infection as follow: total leucocytic count, eosinophil count at admission and SOFA score. The AUC for eosinophil count to predict was 95% with optimal cut off value was 50 cells/mm 3 with a sensitivity of 92.85% and specificity of 93.33% with P value <0.001.Conclusion: the result of the present study revealed that eosinophil counts was ˂50 cells/mm3 at admission time to ICU was a predictor for diagnosis of sepsis in critically ill patients. However, eosinophil counts at admission time to ICU were not a specific indicator of mortality. Recommendations: eosinophil counts are cheap and easily accessible test can be used to guide for sepsis diagnosis and treatment.Larger studies are needed to determine the prognostic value of this test and establish better cutoff values.

Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation

“…They found that admission eosinophil counts of <50 cells/mm 3 could be used as a predictor for sepsis diagnosis in ICU patients, although the admission eosinophil sensitivity and specificity did not predict mortality. 18 In another study by Swaminathan et al, the absolute eosinophil count was a reliable marker of mortality in patients with perforative peritonitis, as the values decreased in patients who did not survive. 19 Acute exacerbation of chronic obstructive pulmonary disease is frequently seen in emergency departments.…”

Validity of Eosinopenia in Bacterial Sepsis Patients Based on Sepsis-3 Consensus Criteria

“…Therefore, eosinopenia may represent an excellent marker for the diagnosis of bacterial sepsis. [5][6][7]11,12,15 The study by Gil in 2003 showed that sepsis was strongly correlated with an eosinophil count <40 cells/mm 3 and WBC count >10,000 cells/mm 3 with specificity and PPV of 100% and related to bacterial infectious diseases. 15 Abidi's study in 2008 showed that eosinopenia (cut-off value of ≤ 50 cells/mm 3 ) could be used as sepsis marker in patients hospitalized in the ICU with a sensitivity of 80% and specificity of 91%.…”

“…As a cheap and always measured test, eosinopenia offers a higher reliability than other hematology markers of infection such as leucocytosis and neutrophilia. [4][5][6]19 In acute…”

“…1 Eosinopenia defined if the absolute eosinophil count with fluorescent flowcytometry method is ≤ 50 cells/mm 3 . [5][6][7] The validity of eosinopenia were assessed by comparing the count of eosinophil cell between bacterial sepsis patients and non-bacterial sepsis patients at the time of evaluate.…”

“…3,4 More than 100 different molecules have been suggested as useful biomarkers of sepsis. 5 Unfortunately, until now, the availability of infection markers that have high validity has not been found. An ideal infection marker would be highly sensitive and specific, easy to perform, rapid, cheap, and related to prognosis and disease severity.…”