title: Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Intensive Care Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco. abidikhalid@invivo.edu
authors.forename: Khalid
authors.initials: K
authors.lastname: Abidi
authors.forename: Ibtissam
authors.initials: I
authors.lastname: Khoudri
authors.forename: Jihane
authors.initials: J
authors.lastname: Belayachi
authors.forename: Naoufel
authors.initials: N
authors.lastname: Madani
authors.forename: Aicha
authors.initials: A
authors.lastname: Zekraoui
authors.forename: Amine Ali
authors.initials: AA
authors.lastname: Zeggwagh
authors.forename: Redouane
authors.initials: R
authors.lastname: Abouqal
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D004804:Eosinophils; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007970:Leukopenia / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers