Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 5 ( 2016 ) > List of Articles

BRIEF COMMUNICATION

Exploration of eosinopenia as a diagnostic parameter to differentiate sepsis from systemic inflammatory response syndrome: Results from an observational study

Debashish Dhar, Ashish Garg, Rahul Singh, Dimple Anand, Seema Bhargava, Lalit M. Srivastava, Imran Gafoor

Keywords : negative predictive value, procalcitonin, sepsis, systemic inflammatory response syndrome,Absolute eosinophil count

Citation Information : Dhar D, Garg A, Singh R, Anand D, Bhargava S, Srivastava LM, Gafoor I. Exploration of eosinopenia as a diagnostic parameter to differentiate sepsis from systemic inflammatory response syndrome: Results from an observational study. Indian J Crit Care Med 2016; 20 (5):285-290.

DOI: 10.4103/0972-5229.182199

License: CC BY-ND 3.0

Published Online: 00-05-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim of the Study: Initial differentiation of sepsis from systemic inflammatory response syndrome (SIRS) is of prime importance for early institution of appropriate treatment. This study aimed to compare the differential diagnostic efficacy of absolute eosinophil count (AEC - a routinely available economic marker) with total leukocyte count (TLC) and procalcitonin (PCT - a costly marker available only in specialized settings). Materials and Methods: In this prospective observational study, 170 patients of sepsis (severe sepsis = 125; SIRS = 45) were enrolled. AEC, TLC, and PCT were measured in the blood of all patients at the time of admission and data analyzed statistically. Results: Median AEC was 0 cells/mm3 in both SIRS and sepsis. TLC and PCT levels were significantly higher (P < 0.001) in culture negative, culture positive, and overall sepsis groups in comparison to SIRS group. At a cutoff of < 50 cells/mm3, AEC demonstrated a sensitivity and specificity of 23% and 68%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of TLC were 57%, 71%, 85%, 37% and of PCT were 82.4%, 82.2%, 93%, and 63%, respectively with area under curve of 0.455 for AEC, 0.640 for TLC, 0.908 for PCT. Conclusions: This study suggests that eosinopenia is not a reliable diagnostic tool to differentiate sepsis from SIRS. PCT and TLC are better differential diagnostic biomarkers.


PDF Share
  1. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. NCHS Data Brief 2011; Š62:1-8.
  2. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med 2007;35:1244-50.
  3. van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis 2008;8:32-43.
  4. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.
  5. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
  6. Peres Bota D, Lopes Ferreira F, Mélot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med 2004;30:811-6.
  7. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med 2006;34:344-53.
  8. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-9.
  9. Anand D, Das S, Bhargava S, Srivastava LM, Garg A, Tyagi N, et al. Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome: A prospective, observational, cohort study. J Crit Care 2015;30:218.e7-12.
  10. Bass DA, Gonwa TA, Szejda P, Cousart MS, DeChatelet LR, McCall CE. Eosinopenia of acute infection: Production of eosinopenia by chemotactic factors of acute inflammation. J Clin Invest 1980;65:1265-71.
  11. Zappert J. About the occurring of eosinophilic cells in human bleeding. Z Klin Med 1893;23:227-308.
  12. Metcalf D, Burgess AW, Johnson GR, Nicola NA, Nice EC, DeLamarter J, et al. In vitro actions on hemopoietic cells of recombinant murine GM-CSF purified after production in Escherichia coli: Comparison with purified native GM-CSF. J Cell Physiol 1986;128:421-31.
  13. Metcalf D, Begley CG, Nicola NA, Johnson GR. Quantitative responsiveness of murine hemopoietic populationsin vitro andin vivo to recombinant multi-CSF (IL-3). Exp Hematol 1987;15:288-95.
  14. Yamaguchi Y, Suda T, Suda J, Eguchi M, Miura Y, Harada N, et al. Purified interleukin 5 supports the terminal differentiation and proliferation of murine eosinophilic precursors. J Exp Med 1988;167:43-56.
  15. Abidi K, Khoudri I, Belayachi J, Madani N, Zekraoui A, Zeggwagh AA, et al. Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units. Crit Care 2008;12:R59.
  16. Shaaban H, Daniel S, Sison R, Slim J, Perez G. 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? J Crit Care 2010;25:570-5.
  17. Garnacho-Montero J, Huici-Moreno MJ, Gutiérrez-Pizarraya A, López I, Márquez-Vácaro JA, Macher H, et al. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Crit Care 2014;18:R116.
  18. Smithson A, Perelló R, Nicolas JM. Is eosinopenia a reliable marker of sepsis? Crit Care 2009;13:409.
  19. Setterberg MJ, Newman W, Potti A, Smego RA Jr. Utility of eosinophil count as predictor of bacteremia. Clin Infect Dis 2004;38:460-1.
  20. Bass DA. Behavior of eosinophil leukocytes in acute inflammation. I. Lack of dependence on adrenal function. J Clin Invest 1975;55:1229-36.
  21. Bass DA. Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation. J Clin Invest 1975;56:870-9.
  22. Schiffmann E, Corcoran BA, Wahl SM. N-formylmethionyl peptides as chemoattractants for leucocytes. Proc Natl Acad Sci U S A 1975;72:1059-62.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.