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

Eosinopenia is a reliable marker of sepsis on admission in medical intensive care units
from Critical Care - Latest articles by Khalid K Abidi, Ibtissam I Khoudri, Jihane J Belayachi, Naoufel N Madani, Aicha A Zekraoui, Amine Ali AA Zeggwagh and Redouane R Abouqal
Introduction
Eosinopenia is a cheap and "forgotten" marker of acute infection that has never been evaluated before in intensive care units (ICUs). The aim of this study was to test the value of eosinopenia in the diagnosis of sepsis in patients admitted to ICUs.
Methods: A prospective study of consecutive adult patients admitted to a 12-bed medical ICU. 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. In discriminating non-infected (negative+SIRS) and infected (sepsis+severe sepsis+septic shock) groups, the area under the Receiver Operating Characteristic (ROC) curve was 0.89 (95%Confidence Interval [CI]; 0.83-0.94). Eosinophils <50cells/mm^3 yielded a sensitivity 80% (95%CI; 71-86%), specificity 91% (95%CI; 79-96%), positive likelihood ratio (LR+) 9.12(95%CI; 3.9-21), and negative likelihood ratio (LR-) 0.21(95%CI; 0.15-0.31). In discriminating SIRS and infected groups, the area under ROC curve was 0.84(95%CI; 0.74-0.94). Eosinophils<40cells/mm^3 yielded a sensitivity 80%(95%CI; 71-86%), specificity 80%(95%CI; 55-93%), LR+ 4(95%CI; 1.65-9.65), and LR- 0.25(95%CI; 0.17-0.36).

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.