Research

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

Khalid Abidi¹ , Ibtissam Khoudri¹ , Jihane Belayachi¹ , Naoufel Madani¹ , Aicha Zekraoui¹ , Amine Ali Zeggwagh^1,2 and Redouane Abouqal^1,2

¹  Medical Intensive Care Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco

²  Laboratory of Biostatistics, Clincial and Epidemiological Research, Faculté de Médecine et Pharmacie - Université Mohamed V, 10000, Rabat, Morocco

author email corresponding author email

Critical Care 2008, 12:R59doi:10.1186/cc6883

Published:	24 April 2008

See related letter by Smithson et al., http://ccforum.com/content/13/3/409

Abstract

Introduction

Eosinopenia is a cheap and forgotten marker of acute infection that has not been evaluated previously in intensive care units (ICUs). The aim of the present 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 was performed. Eosinophils were measured at ICU admission. Two intensivists blinded to the eosinophils classified patients as negative or with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, or septic shock.

Results

A total of 177 patients were enrolled. In discriminating noninfected (negative + SIRS) and infected (sepsis + severe sepsis + septic shock) groups, the area under the receiver operating characteristic curve was 0.89 (95% confidence interval (CI), 0.83 to 0.94). Eosinophils at <50 cells/mm³ yielded a sensitivity of 80% (95% CI, 71% to 86%), a specificity of 91% (95% CI, 79% to 96%), a positive likelihood ratio of 9.12 (95% CI, 3.9 to 21), and a negative likelihood ratio of 0.21(95% CI, 0.15 to 0.31). In discriminating SIRS and infected groups, the area under the receiver operating characteristic curve was 0.84 (95% CI, 0.74 to 0.94). Eosinophils at <40 cells/mm³ yielded a sensitivity of 80% (95% CI, 71% to 86%), a specificity of 80% (95% CI, 55% to 93%), a positive likelihood ratio of 4 (95% CI, 1.65 to 9.65), and a negative likelihood ratio of 0.25 (95% CI, 0.17 to 0.36).

Conclusion

Eosinopenia is a good diagnostic marker in distinguishing between noninfection 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.