title: [Clinical relevance of leukocyte differential in patients with marked leukocytosis in the emergency room].
abstract: OBJECTIVE
  We analyzed the characteristics of the leukocyte differential and the clinical outcome in patients admitted in an emergency department with marked leukocytosis greater than 20×10(9)G/L.
  
  
  METHODS
  We studied a case series of consecutive patients admitted in an emergency department. The medical records were retrospectively reviewed after patient discharge. Three groups were defined: patients with infectious disorders (group I), noninfectious disorders (group II), and trauma (group III). Admission in intensive care unit (ICU), consciousness impairment or death defined the subgroup S of high severity.
  
  
  RESULTS
  Groups I, II and III comprised, respectively, 150, 95 and 86 patients. The group I presented with higher temperature and neutrophilia (22,2±4.9 vs 20.9±4.0 and 21.1±3.9×10(9)G/L; P<0.001), and more profound eosinopenia (0.058±0.094 versus 0.098±0.170 and 0.092±0.104×10(9)G/L; P<0.001) and lymphopenia (1.16±0.98 vs 1.53±1.04 and 1.73±1.10×10(9)G/L; P<0.001) than the two other groups. Both neutrophilia and lymphopenia were independent predictors of infection by multivariate analysis. Frequencies of admission in ICU were, respectively, 8.7%, 40% and 43% (P<0.001). Leukocyte and neutrophil counts were significantly higher and basophil count significantly lower in subgroup S. Overall, 13.6% of the patients died and were characterized by basopenia.
  
  
  CONCLUSIONS
  Marked leukocytosis indicated severe illness. Lymphopenia, eosinopenia and temperature were significant predictors of infection. A more severe clinical course was correlated with higher neutrophilia and basopenia.
authors.affiliation: Service de gériatrie et médecine interne, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Deibener-Kaminsky
authors.forename: J-F
authors.initials: JF
authors.lastname: Lesesve
authors.forename: S
authors.initials: S
authors.lastname: Grosset
authors.forename: L
authors.initials: L
authors.lastname: Pruna
authors.forename: M-C
authors.initials: MC
authors.lastname: Schmall-Laurain
authors.forename: A
authors.initials: A
authors.lastname: Benetos
authors.forename: P
authors.initials: P
authors.lastname: Kaminsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001491:Basophils / Q000378:metabolism; D004636:Emergency Service, Hospital; D004802:Eosinophilia / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007964:Leukocytosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult