Exploration of eosinopenia as a diagnostic parameter to differentiate sepsis from systemic inflammatory response syndrome: Results from an observational study.
OBJECTIVE
Initial differentiation of sepsis from systemic inflammatory response syndrome (SIRS) is of prime importance for early institution of appropriate treatment. This study aimed to compare the differential diagnostic efficacy of absolute eosinophil count (AEC - a routinely available economic marker) with total leukocyte count (TLC) and procalcitonin (PCT - a costly marker available only in specialized settings).


METHODS
In this prospective observational study, 170 patients of sepsis (severe sepsis = 125; SIRS = 45) were enrolled. AEC, TLC, and PCT were measured in the blood of all patients at the time of admission and data analyzed statistically.


RESULTS
Median AEC was 0 cells/mm(3) in both SIRS and sepsis. TLC and PCT levels were significantly higher (P < 0.001) in culture negative, culture positive, and overall sepsis groups in comparison to SIRS group. At a cutoff of < 50 cells/mm(3), AEC demonstrated a sensitivity and specificity of 23% and 68%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of TLC were 57%, 71%, 85%, 37% and of PCT were 82.4%, 82.2%, 93%, and 63%, respectively with area under curve of 0.455 for AEC, 0.640 for TLC, 0.908 for PCT.


CONCLUSIONS
This study suggests that eosinopenia is not a reliable diagnostic tool to differentiate sepsis from SIRS. PCT and TLC are better differential diagnostic biomarkers.
Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India.
Dimple
D
Anand
Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Sumit
S
Ray
Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India.
Seema
S
Bhargava
Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India.
Lalit M
LM
Srivastava
Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Ashish
A
Garg
Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Imran
I
Gafoor
Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Rahul
R
Singh
Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Debashish
D
Dhar
Absolute eosinophil count; negative predictive value; procalcitonin; sepsis; systemic inflammatory response syndrome