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2017, Number 5

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Med Int Mex 2017; 33 (5)

Usefulness of eosinopenia as prognostic marker of severity in sepsis

Tinoco-Sánchez M, Suárez-Cuenca JA, Rubio-Guerra AF
Full text How to cite this article

Language: Spanish
References: 20
Page: 572-579
PDF size: 465.23 Kb.


Key words:

sepsis, prognostic factor, eosinopenia, SOFA.

ABSTRACT

Background: Sepsis is considered the leading cause of morbidity and mortality in critical patients, it is necessary to have prognostic markers of severity that are increasingly accessible and useful to guide treatment in a timely manner. Evidence demonstrates the usefulness of eosinopenia as a prognostic marker of severity. It has also been shown that eosinopenia may be associated with a higher mortality rate, probably due to the systemic inflammatory environment.
Objetive: To evaluate the utility of low eosinophil counts as a prognostic marker of sepsis severity.
Material and Method: An observational, descriptive, longitudinal and prospective study was done in patients with diagnosis of sepsis of Xoco General Hospital, Mexico City. Data were recorded for registry such as age, sex, chronic-degenerative history, diagnosis, clinical severity of the patient by SOFA scale, and a temporal follow-up was recorded at admission and at 72 h, eosinophil counts and the arithmetic average were performed. Relative eosinopenia was considered with values below the mean of eosinophils. Subsequently, group allocation was performed according to eosinophil count elevation after 72 hours of treatment compared to baseline.
Results: Sixty patients with critical condition requiring multi-organ support were included. The majority were men and the average age was 51 years. Most patients (58%) had diabetes mellitus. When comparing the SOFA score of the group with eosinopenia vs no eosinopenia, significant differences were found, which seems to indicate that the eosinopenia factor has a direct clinical impact on the patient’s condition, that is, the group with eosinopenia presented greater tissue hypoperfusion or organic failure in comparison with the group without eosinopenia. A significant eosinophil elevation was found at 72 hours.
Conclusions: Eosinopenia and improvement of eosinophils after 72 hours of treatment were related to the modification of severity of sepsis. This suggests its usefulness of eosinopenia as a predictor of severity of sepsis.


REFERENCES

  1. Levy MM, Fink MP, Marshall JC, et al; SCCM/ESICM/ACCP/ ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250-1256.

  2. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000 N Engl J Med 2003;348(16):1546.

  3. Carrillo R. Estudio epidemiológico de la sepsis en unidades de terapia intensiva mexicanas. Cir Ciruj 2009;77:301-308.

  4. Bone RC, Grodzin CJ, et al. Sepsis: A new hypothesis for pathogenesis of the disease process Chest 1997;112235- 243.

  5. Gil H, Magy N, Mauny F, et al Dupond valeur de l’éosinopénie dans le diagnostic des syndromes inflammatoires : un « vieux » marqueur revisité. Rev Med Interne 2003;24:431-435.

  6. Gómez HG, Rugeles MT, Jaimes A. Características inmunológicas claves en la fisiopatología de la sepsis. Infect 2015;19:40-46.

  7. Kaminsky P, Deibener J, Lesesve JF, Humbert JC. Variations des paramètres de l’hémogramme au cours des infections. Rev Med Interne 2002;23:132-136.

  8. Abidi K, Khoudri I, Belayachi J, Madani N, et al. Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units. Crit Care 2008;12:R59.

  9. Rothenberg ME. Eosinophilia. N Engl J Med 1998;338:1592-600.

  10. Bass DA, Gonwa TA, Szejda P, et al. Eosinopenia of acute infection: production of eosinopenia by chemotactic factors of acute inflammation. J Clin Invest 1980;65:1265-71.

  11. Venet F, Lepape A, Debard AL, et al. The Th2 response as monitored by CRTH2 or CCR3 expression is severely decreased during septic shock. Clin Immunol 2004;113(3):278-84.

  12. Rangel-Frausto MS, Pittet D, Costigan M, et al. La historia natural del síndrome de respuesta inflamatoria sistémica (SIRS). Un estudio prospectivo. JAMA 1995;273:117.

  13. van Vught LA, Klein Klouwenberg PM, Spitoni C. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA 2016 Apr 12;315(14):1469-79.

  14. Labelle A, Juang P, Reichley R. The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment. Crit Care Med 2012 Jul;40(7):2016-21.

  15. Zahar JR, Timsit JF, Garrouste-Orgeas M. et al. Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med 2011 Aug;39(8):1886-95.

  16. Kaplan D, Casper TC, Elliott CG, et al. TEV incidencia y factores de riesgo en pacientes con sepsis grave y shock séptico. Chest 2015;148:1224.

  17. Kumar A, Roberts D, Madera KE, et al. Duración de la hipotensión antes de la iniciación de la terapia antimicrobiana eficaz es el factor determinante de la supervivencia en humanos shock séptico. Med Care Crit 2006;34:1589.

  18. Prescott HC, Dickson RP, Rogers MA, et al. Hospitalization type and subsequent severe sepsis. Am J Respir Crit Care Med 2015;192:581.

  19. Lawrence YR, Raveh D, Rudensky B, Munter G. Extreme leukocytosis in the emergency department. Q J Med 2007;100:217-223.

  20. Sundén-Cullberg J, Norrby-Teglund A, Rouhiainen A, Rauvala H, et al. Persistent elevation of high mobility group box-1 protein (HMGB1) in patients with severe sepsis and septic shock Crit Care Med 2005;33:564-573.




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Med Int Mex. 2017;33