title: Low eosinophil count predicts in-hospital mortality in cirrhosis with systemic inflammatory response syndrome.
abstract: BACKGROUND
  Absolute eosinophil count (AEC) and procalcitonin (PCT) level may have a prognostic value in critically ill patients. However, their role in cirrhotic patients has never been studied. We evaluated the role of AEC and PCT, obtained at admission, in predicting in-hospital mortality in cirrhotic patients with systemic inflammatory response syndrome (SIRS).
  
  
  METHODS
  In consecutive cirrhotic patients with SIRS (with or without sepsis), the levels of AEC and PCT were estimated at admission. Their outcome was correlated with these baseline parameters.
  
  
  RESULTS
  One hundred patients were enrolled [median age 52 (range 17-78) years, 84% men]. The etiology of cirrhosis was alcohol (47%), cryptogenic (35%), viral (13%), and others (5%). Their median model for end-stage liver disease (MELD) and Child-Turcotte-Pugh scores were 24 (range 6-40) and 11 (range 5-15), respectively. Infection was present in 59 patients and the rest of the 41 patients had SIRS without infection. There was a significant difference between the median levels of AEC and PCT between patients who had infection and those who did not have infection (P<0.01). Sixty-three patients recovered from SIRS and were discharged, 33 patients died, and four patients received orthotopic liver transplantation during the same admission. Baseline AEC and PCT levels were significantly different between patients who recovered and died. On multivariate analysis, baseline AEC values could independently predict in-hospital mortality, in addition to MELD and serum sodium. The area under receiver operating characteristic curve of AEC for predicting mortality was 0.785, and the best cutoff of AEC, obtained by Youden's index, was 104 cells/cumm, indicating that patients with baseline AEC values less than 104 cells/cumm had higher in-hospital mortality (sensitivity 78%, specificity 70%, positive predictive value 60%, negative predictive value 85%, and accuracy 73%).
  
  
  CONCLUSIONS
  In critically ill cirrhotic patients with SIRS, a baseline AEC value of less than 104 cells/cumm accurately predicts in-hospital mortality. The prediction of mortality by AEC is independent of the MELD score and serum sodium.
authors: Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors: Hardik L
authors: HL
authors: Kotecha
authors: Anil
authors: A
authors: Arora
authors: Romesh
authors: R
authors: Chawlani
authors: Jay
authors: J
authors: Toshniwal
authors: Naresh
authors: N
authors: Bansal
authors: Pankaj
authors: P
authors: Tyagi
authors: Praveen
authors: P
authors: Sharma
authors: Mandhir
authors: M
authors: Kumar
authors: Ashish
authors: A
authors: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004804:Eosinophils / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide