1. bookVolume 57 (2019): Issue 2 (June 2019)
Journal Details
License
Format
Journal
First Published
30 Mar 2015
Publication timeframe
4 times per year
Languages
English
access type Open Access

Eosinophil count (EC) as a diagnostic and prognostic marker for infection in the internal medicine department setting

Published Online: 20 Jun 2019
Page range: 166 - 174
Received: 09 Nov 2018
Journal Details
License
Format
Journal
First Published
30 Mar 2015
Publication timeframe
4 times per year
Languages
English
Abstract

Introduction. Eosinopenia has been previously investigated as a marker to differentiate infectious from non-infectious diagnoses and as a prognostic marker. Most previous studies were conducted in intensive care unit patients. Our study focuses on the value of eosinopenia in patients admitted to the Internal Medicine department.

Methods. We retrospectively analyzed 271 consecutive patients with infection and 31 patients presenting with fever or inflammatory syndrome and a non-infectious diagnosis. We evaluated and compared the following markers for differentiating infectious from non-infectious diagnoses: eosinophil count [EC], CRP, WBC and neutrophil-to-lymphocyte count ratio [NLCR]. We also evaluated the value of eosinopenia as a monitoring parameter in patients with infections.

Results. Eosinopenia at admission was found in 71% of patients with infection compared to 32% in the non-infection group. EC and NLCR were moderate markers for discriminating infection from non-infection, with an area under the receiver operating characteristic curve of 0.789 and 0.718 respectively. Significant eosinopenia (≤ 10/µL) had a high specificity (90%) for diagnosing infections. High EC at admission (> 400/µL) was rare in the infection group (1.5%), but not uncommon in the non-infection group (25.8%). Persistent eosinopenia was noted in non-survivors, compared to the rapid normalization of EC in survivors.

Conclusions. Among patients presenting with fever and/or high inflammatory markers a low EC is supportive of infection, while a high EC may suggest non-infectious diagnoses. The persistence/ resolution of eosinopenia may be a useful monitoring parameter to predict response to therapy.

Keywords

1. BASS D.A. Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation. J Clin Invest. 1975;56(4):870-9.Search in Google Scholar

2. BASS D.A., GONWA T.A., SZEJDA P., COUSART M.S., DECHATELET L.R., MCCALL C.E. Eosinopenia of acute infection: Production of eosinopenia by chemotactic factors of acute inflammation. J Clin Invest. 1980;65(6):1265-71.Search in Google Scholar

3. DREYFUSS F., FELDMAN S. Eosinopenia induced by emotional stress. Acta Med Scand. 1952;144(2):107-13.Search in Google Scholar

4. IVES M., DACK G.M. Alarm reaction and normal blood picture in Macaca mulatta. J Lab Clin Med. 1956;47(5):723-9.Search in Google Scholar

5. BEST W.R., MUEHRCKE R.C., KARK R.M. Studies on adrenocortical eosinopenia: a clinical and statistical evaluation of four-hour eosinophil response test. J Clin Invest. 1952;31(7):733-42.Search in Google Scholar

6. HILLS A.G., FORSHAM P.H., FINCH C.A. Changes in circulating leukocytes induced by the administration of pituitary adrenocorticotrophic hormone in man. Blood. 1948;3(7):755-68.Search in Google Scholar

7. GIL H., MAGY N., MAUNY F., DUPOND J.L. [Value of eosinopenia in inflammatory disorders: an “old” marker revisited]. Rev Med Interne. 2003;24(7):431-5.Search in Google Scholar

8. ABIDI K., KHOUDRI I., BELAYACHI J., MADANI N., ZEKRAOUI A., ZEGGWAGH A.A., et al. Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units. Crit Care. 2008;12(2):R59.Search in Google Scholar

9. SMITHSON A., PERELLO R., NICOLAS J.M. Is eosinopenia a reliable marker of sepsis? Crit Care. 2009;13(3):409.Search in Google Scholar

10. SHAABAN H., DANIEL S., SISON R., SLIM J., PEREZ G. Eosinopenia: Is it a good marker of sepsis in comparison to procalcitonin and C-reactive protein levels for patients admitted to a critical care unit in an urban hospital? J Crit Care. 2010;25(4):570-5.Search in Google Scholar

11. GARNACHO-MONTERO J., HUICI-MORENO M.J., GUTIERREZ-PIZARRAYA A., LOPEZ I., MARQUEZ-VACARO J.A., MACHER H., et al. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Crit Care. 2014;18(3):R116.Search in Google Scholar

12. ANAND D., RAY S., BHARGAVA S., SRIVASTAVA L.M., GARG A., GAFOOR I., et al. Exploration of eosinopenia as a diagnostic parameter to differentiate sepsis from systemic inflammatory response syndrome: Results from an observational study. Indian J Crit Care Med. 2016;20(5):285-90.Search in Google Scholar

13. LAVOIGNET C.E., LE BORGNE P., SLIMANI H., FORATO M., KAM C., KAUFFMANN P., et al. [Relevance of eosinopenia as marker of sepsis in the Emergency Department]. Rev Med Interne. 2016;37(11):730-34.Search in Google Scholar

14. PITMAN M.C., ANSTEY N.M., DAVIS J.S. Eosinophils in severe sepsis in northern Australia: do the usual rules apply in the tropics? Crit Care Med. 2013;41(10):e286-8.Search in Google Scholar

15. MITRE E. Eosinophilia: a diagnostic clue for nonbacterial diseases in patients with systemic inflammatory response syndrome. Crit Care Med. 2013;41(10):2464-5.Search in Google Scholar

16. ABIDI K., BELAYACHI J., DERRAS Y., KHAYARI M.E., DENDANE T., MADANI N., et al. Eosinopenia, an early marker of increased mortality in critically ill medical patients. Intensive Care Med. 2011;37(7):1136-42.Search in Google Scholar

17. TERRADAS R., GRAU S., BLANCH J., RIU M., SABALLS P., CASTELLS X., et al. Eosinophil count and neutrophillymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PLoS One. 2012;7(8):e42860.Search in Google Scholar

18. MERINO C.A., MARTINEZ F.T., CARDEMIL F., RODRIGUEZ J.R. Absolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit. J Crit Care. 2012;27(4):394-9.Search in Google Scholar

19. KARAKONSTANTIS S., KALEMAKI D., TZAGKARAKIS E., LYDAKIS C. Pitfalls in studies of eosinopenia and neutrophil-to-lymphocyte count ratio. Infect Dis. 2018;50(3):163-74.Search in Google Scholar

20. DAVIDO B., MAKHLOUFI S., MATT M., CALIN R., SENARD O., PERRONNE C., et al. Changes in eosinophil count during bacterial infection: revisiting an old marker to assess the efficacy of antimicrobial therapy. Int J Infect Dis. 2017;61:62-66.Search in Google Scholar

21. KARAKONSTANTIS S., KALEMAKI D. Correspondence regarding “Changes in eosinophil count during bacterial infection: revisiting an old marker to assess the efficacy of antimicrobial therapy”. Int J Infect Dis. 2018;66(144.Search in Google Scholar

22. DAVIDO B., MOUSSIEGT A., DE TRUCHIS P., SALOMON J., DINH A., DAVIDO G. Interest in the monitoring of eosinophil count as a marker of the response to antimicrobial therapy: In response to Karakonstantis and Dimitra. Int J Infect Dis. 2018;66:145-46.Search in Google Scholar

23. NAESS A., NILSSEN S.S., MO R., EIDE G.E., SJURSEN H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017;45(3):299-307.Search in Google Scholar

24. NAESS A., MO R., NILSSEN S.S., EIDE G.E., SJURSEN H. Infections in patients hospitalized for fever as related to duration and other predictors at admittance. Infection. 2014;42(3):485-92.Search in Google Scholar

25. KARAKONSTANTIS S., KALEMAKI D. Correspondence to “Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever”. Infection. 2017;10.1007/s15010-017-1069-1Search in Google Scholar

26. VELISSARIS D., PANTZARIS N.D., BOUNTOURIS P., GOGOS C. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Intern Med. 2018;56(3):153-57.Search in Google Scholar

27. WOODHEAD M., BLASI F., EWIG S., GARAU J., HUCHON G., IEVEN M., et al. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1-59.Search in Google Scholar

28. KIRIYAMA S., TAKADA T., STRASBERG S.M., SOLOMKIN J.S., MAYUMI T., PITT H.A., et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):24-34.Search in Google Scholar

29. LI J.S., SEXTON D.J., MICK N., NETTLES R., FOWLER V.G., JR., RYAN T., et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633-8.Search in Google Scholar

30. EUROPEAN ASSOCIATION FOR THE STUDY OF THE L. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397-417.Search in Google Scholar

31. EFSTATHIOU S.P., PEFANIS A.V., TSIAKOU A.G., SKEVA, II, TSIOULOS D.I., ACHIMASTOS A.D., et al. Fever of unknown origin: discrimination between infectious and non-infectious causes. Eur J Intern Med. 2010;21(2):137-43.Search in Google Scholar

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