Elsevier

Journal of Critical Care

Volume 27, Issue 4, August 2012, Pages 394-399
Journal of Critical Care

Sepsis
Absolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit,☆☆

https://doi.org/10.1016/j.jcrc.2011.10.010Get rights and content

Abstract

Introduction

Eosinophils in the circulating blood undergo apoptosis during sepsis syndromes induced by the action of certain cytokines.

Objective

The aim of the study was to evaluate the absolute eosinophils count (EC) as a marker of mortality in severe sepsis and septic shock.

Patients and Method

A prospective cohort study of patients with a diagnosis of sepsis or septic shock admitted to the intensive care unit (ICU) of the Dr Gustavo Fricke Hospital between January 2008 and December 2009 was conducted. Daily EC in all patients was analyzed. Receiver operating characteristic curve analysis was used to assess the performance of the diagnostic test.

Results

We studied a total of 240 patients. The median age was 62 years (interquartile range [IQR], 48-72 years), and 67 (27.9%) died. The median EC in patients who died was 43 (IQR, 14-121), whereas in surviving patients, it was 168 (IQR, 98-292) (P < .001). When the EC on the fifth day of hospital stay was assessed, an area under the curve (AUC) of 0.64 (95% confidence interval, 0.55-0.73) was observed. Eosinophils count at intensive care unit discharge showed an area under the curve of 0.81 (95% confidence interval, 0.76-0.87).

Discussion

Eosinophils counts were lower in patients who died of sepsis than in those who survived, but its clinical usefulness seems limited. Their role as an indicator of clinical stability seems to be important.

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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    Conflicts of interest statement: None to disclose.

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