SepsisAbsolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit☆,☆☆
Introduction
Sepsis and septic shock are high-frequent conditions in intensive care units (ICUs) worldwide. They are responsible for about 10% of admissions to these units, and they are associated with a significant mortality rate up to 30% [1]. This rate has led to the search for tools allowing precise prognostic evaluation of these patients [2]. Thus, multiple assessment methods have subsequently appeared, such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system, and different tests showing a prognostic capacity, such as C-reactive protein (CRP) [3], [4], [5], [6]; amyloid A protein [7]; interleukins 6 [8], 8 [8], and 10 [3]; a triggering receptor expressed on myeloid cells 1 [9]; and serum procalcitonin levels [4], [5], [6]. All these tests have shown an ability, with different degrees of accuracy, to establish diagnosis and prognosis for each septic episode, but none has proven to be the ideal indicator.
Accordingly, some recent studies have appeared concerning the value of an old marker of infection used during the first decade of the last century as an indicator of sepsis: eosinopenia [10], [11], [12]. Eosinophils are cells that normally account for only 1% to 3% of total leukocytes, with a maximum of 350 cells/mm [3], [13]. The reduction in the number of eosinophils is still an unexplained phenomenon, but it may be linked to the action of inflammatory cytokines, such as tumor necrosis factor, and acute phase reactants, such as glucocorticoids and epinephrine [12]. However, studies report that although correlation with some of these mediators does exist, it is weak. In addition, a reduction in eosinophils CRTH2 (Chemoattractant receptor homologous molecule expressed on Th2 lymphocytes) and CCR3 (C-C chemokine receptor type 3) expression during septic shock and a persistence of low levels of them in nonsurvivors have been observed [14].
Gil et al [15] demonstrated significant differences in mean values of eosinophils between patients with infectious and noninfectious episodes, and counts less than 40 cells/mm3 were strongly related to bacterial etiology. Furthermore, in a recent study, Abidi et al [16] report that eosinopenia constitutes a good diagnostic marker in identifying sepsis conditions and discriminating their severity. Eosinopenia has also been reported as an important prognostic marker in the sepsis syndromes even after adjustments for confounding factors such as comorbidities, APACHE II, and Sequential Organ Failure Assessment (SOFA) scores, and the requirement of mechanical ventilation is made [17].
The purposes of the present study were to assess the absolute eosinophils count (EC) as a marker of mortality in patients with sepsis or septic shock conditions and to evaluate whether it has any ability to predict mortality.
Section snippets
Patients and method
A prospective study of patients with diagnosis of severe sepsis or septic shock admitted to the ICU of the Dr Gustavo Fricke Hospital in Viña del Mar was conducted between January 2008 and December 2009. The inclusion criteria involved patients with sepsis or septic shock according to the diagnostic criteria established by the American College of Chest Physicians and the Society of Critical Care Medicine [18], [19]. The following exclusion criteria were applied: patients aged younger than 18
Results
A total of 255 patients were enrolled into the study; 11 of these patients were excluded because they did not meet the inclusion criteria, and 4 were lost to follow-up, resulting in only 240 eligible patients (Fig. 1). One hundred thirty-six were male (56.7%), whereas 104 were female (43.3%), with a median age of 62 years (interquartile range [IQR], 48-72 years). One hundred seventy-three patients survived their sepsis episode, and mortality occurred in 67 (27.9%). Patient characteristics are
Discussion
Mortality observed in the present study is in accordance with the findings described in international literature. Older age and higher APACHE II or SOFA score were found in nonsurvivors, which is also consistent with other reports. Abdominal focus was the most frequent septic focus found, which is not surprising considering that the Dr Gustavo Fricke Hospital is an institution with a large surgery unit; thus, most of the abdominal surgery performed in this center requires exhaustive
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Eosinopenia and post-hospital outcomes in critically ill non-cardiac vascular surgery patients
2019, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Eosinopenia is a prognostic marker for sepsis and mortality of critically ill patients [17,18]. Eosinopenia is associated with increased risk of death after acute cerebral infarction [19] and bacteremia [20], and provides good discrimination between infection and non-infection at intensive care unit admission [21,22]. While studies suggest that biomarkers may be predictive of in-hospital outcomes, limited information exists on long term survival of critically ill patients following vascular surgery.
Eosinopenia in 2018
2019, Revue de Medecine InterneRelevance of eosinopenia as marker of sepsis in the Emergency Department
2016, Revue de Medecine InterneStaphylococcus aureus enterotoxins a and B inhibit human and mice eosinophil chemotaxis and adhesion in vitro
2014, International ImmunopharmacologyCitation Excerpt :It is well-known that that eosinophil counts in blood can be markedly elevated in allergic conditions such as asthma [44]. As opposed, in other pathological conditions such as sepsis and severe bacterial infections, the number of circulating eosinophils can be significantly reduced [45–47]. Eosinopenia has therefore been suggested to constitute a good diagnostic marker to identify sepsis conditions and discriminating their severity [46], as well as to indicate mortality in patients with exacerbations of obstructive pulmonary disease [48,49].