Eosinopenia: Is it a good marker of sepsis in comparison to procalcitonin and C-reactive protein levels for patients admitted to a critical care unit in an urban hospital?

doi:10.1016/j.jcrc.2010.03.002

Journal of Critical Care

Volume 25, Issue 4, December 2010, Pages 570-575

https://doi.org/10.1016/j.jcrc.2010.03.002 Get rights and content

Abstract

Introduction

The role of eosinopenia as a marker of sepsis has recently been evaluated. The aim of our study was to test the value of eosinopenia as a diagnostic marker of sepsis in comparison to procalcitonin and C-reactive protein levels.

Methods

A prospective study of critically ill adult patients admitted to the medical intensive care unit at an urban hospital. Procalcitonin, C-reactive protein (CRP) levels and eosinophil counts were measured on admission. Patients were classified as non-infected or infected by the medical residents, fellows, and attendings.

Results

A total of 68 patients were enrolled into the study. At a cut-off value of 70 mg/L, the CRP level yielded a sensitivity of 94%, a specificity of 84%, a positive predicted value (PPV) of 83% and a negative predicted value (NPV) of 94%. At a cutoff value of 1.5 μg/L, the sensitivity of the procalcitonin test was 84%, specificity of 92%, PPV 90%, and NPV of 87%. The eosinophil cell count (cutoff of 50 cells/mm³) produced a sensitivity of 81%, specificity of 65%, a PPV of 66%, and a NPV of 80%.

The comparison of the eosinophil cell count (<50 cells/mm³) and procalcitonin levels among the non-infected and infected groups showed a significant statistical difference (Fisher exact test, P = .0239). There was no statistical difference observed when comparisons were made between CRP levels and eosinophil count (Fisher exact test, P = .12). There was also a lack of significant statistical difference when CRP levels were compared to procalcitonin levels (Fisher exact test, P = .49).

Conclusion

Eosinopenia is a very sensitive yet not specific serological marker of sepsis in the intensive care unit and can be utilized to guide physicians in the diagnosis of sepsis.

Introduction

The early diagnosis of sepsis plays an integral role in the morbidity and mortality of patients admitted to the intensive care unit (ICU) because it ensures the early administration of antibiotics therapy. The clinical parameters that make up the sepsis syndrome are not specific and frequently overlap with the clinical presentation of a systemic inflammatory response syndrome (SIRS) secondary to other noninfectious causes [1], [2], [3].

There is no ideal marker of infection that is highly specific, highly sensitive, easy to measure, rapid, inexpensive, and correlated with the severity and prognosis of infection. Some studies have evaluated the role of measuring eosinophil count to assist in the early diagnosis of infection in patients admitted to the critical care unit [4]. More recent studies have looked at the role of procalcitonin levels and triggering receptor expressed on myeloid cells–1 and their ability to differentiate infectious from noninfectious causes of SIRS [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15].

These tests are usually expensive and this coupled with the fact that it takes a long time for the results to be attained, does not make them ideal for the early diagnosis of sepsis. Eosinopenia is a common inflammatory response to acute infection [16], [17], [18], and it was first reported by Zappert et al in 1893 [17]. It has been assumed that the eosinopenia seen in acute infection is related to the production of stress-related chemo-tactic factors [19]. Gil et al studied the role of eosinopenia in inflammatory syndromes and they concluded that sepsis was strongly associated with hyperleucocytosis above 10 000 cells/mm³ and eosinophils counts under 40 cells/mm³[20]. Abidi et al conducted the first study to highlight the diagnostic value of eosinopenia in distinguishing infection from non-infection in patients admitted to the ICU by comparing it to CRP [4]. However, in the Abidi et al study, eosinopenia was a moderate marker in discriminating between SIRS and infection in newly admitted critically ill patients.

The aim of this study was to compare the diagnostic value of eosinopenia, to differentiate infectious and non-infectious causes of SIRS, with procalcitonin and CRP levels in newly admitted ICU patients in an inner city hospital.

Section snippets

Study design

A prospective study was conducted of adult patients admitted to a medical ICU (MICU) of St Michael's Medical Center, an inner city teaching hospital in Newark, NJ, between August 2008 and March 2009.

Patients who died or were discharged within 24 hours after admission were excluded from the study. Surgery patients were not included in the study because they are admitted to a different unit in our institution. The study protocol was approved by the institutional review board of St Michael's

Characteristics of the study sample

68 patients who were admitted to the ICU during the study period were enrolled into the study. 38 of these were Nursing Home patients.

In all, there were 24 Hispanics, 30 African Americans, 13 whites, and 1 Asian. The median age of the study population was 66 (interquartile range, 59-77). There were 33 males and 35 females.

At the time of admission, 31 (46%) of 68 patients had an infection based on microbiological cultures and radiograph evidence. Patients were classified as follows (Fig. 1): no

Discussion

Our present study is the second of its type to investigate the role of eosinopenia in the differentiation of non-infectious and infectious causes of SIRS in patients admitted to the MICU.

Procalcitonin levels, however, seem to be the most promising of all the markers studied so far [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. However, the limiting factor of this test, in many institutions, continues to be its price and the time it takes to get the results (>24 hours in our

Conclusion

Eosinophil counts >50 cells/mm³ are strongly associated with lack of infection in patients admitted to the critical care unit. This cheap and easily accessible test can be used to guide the appropriate use of antibiotics in the intensive care setting. Larger studies are needed to determine the prognostic value of this test and establish better cutoff values.

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Eosinopenia: Is it a good marker of sepsis in comparison to procalcitonin and C-reactive protein levels for patients admitted to a critical care unit in an urban hospital?

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Section snippets

Study design

Characteristics of the study sample

Discussion

Conclusion

Chest

Lancet

Rev Med Interne

Clin Biochem

New concepts in sepsis

Curr Opin Crit Care

Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units

Crit Care

Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children

Intensive Care Med

Comparison of procalcitonin and C-reactive protein as markers of sepsis

Crit Care Med

Discrimination of infectious and non infectious causes of early acute respiratory distress syndrome by procalcitonin

Crit Care Med

Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients

Crit Care Med

Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis and septic shock

Crit Care

Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit

Crit Care Med