Sunday April 27 , 2008
Eosinopenia as a reliable marker of sepsis ?

See this interesting observation from a 12 bed medical ICU !

Introduction: The marked reduction in number of circulating eosinophil leucocytes in acute infection was first described by Zappert in 1893, and was utilized during the first quarter of the last century as a useful diagnostic sign.

Methods: Eosinophils were measured at ICU admission. Two intensivists blinded to eosinophils classified patients as

• negative
• systemic inflammatory response syndrome (SIRS),
• sepsis,
• severe sepsis, and
• septic shock
  

Results: A total of 177 patients were enrolled.

A: In discriminating between non-infected (negative+SIRS) and infected (sepsis+severe sepsis+septic shock) groups,

Eosinophils less than 50cells/mm^3 yielded a

• sensitivity 80% and specificity 91%,
  positive likelihood ratio (LR+) 9.12, and negative likelihood ratio (LR-) 0.21

B: In discriminating between SIRS and infection groups

Eosinophils less than 40cells/mm^3 yielded a

• sensitivity 80% and specificity 80%,
• LR+ 4, and LR- 0.25
  

Conclusions:

Eosinopenia is a good diagnostic marker in distinguishing between non-infection and infection, but is a moderate marker in discriminating between SIRS and infection in newly admitted critically ill patients. Eosinopenia may become a helpful clinical tool in ICU practices.

Reference: click to get abstract / article

1. Eosinopenia is a reliable marker of sepsis on admission in medical intensive care units - Critical Care 2008, 12:R59, Full article in pdf available here