Low Absolute Eosinophil Count Predicts In-Hospital Mortality in Cirrhosis With Systemic Inflammatory Response Syndrome

Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy

BACKGROUND

Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.

METHODS

A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.

RESULTS

A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.

CONCLUSIONS

Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.

CLINICAL RELEVANCE

Early identification of sepsis since the emergency department (ED) triage is challenging Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88).

Eosinophil count: a predictor of in-hospital mortality in a cohort of cirrhosis patients with sepsis

Background

Declining eosinophil count has recently been associated with sepsis. Thus, absolute eosinophil count (AEC) can be used as a marker of the severity of sepsis, which helps in the early identification of high-risk patients, and better management can be offered to such patients. The aim of this study was to assess whether AEC at the time of ICU admission can be used as a predictor of in-hospital mortality in cirrhotics with sepsis.

Results

This was a retrospective study which was conducted in 105 cirrhotic patients admitted with sepsis in the Department of Gastroenterology, Medical College Trivandrum, from May 2014 to October 2014. Every consecutive patient with cirrhosis and sepsis (defined as systemic inflammatory response syndrome (SIRS) and the presence of infections) admitted to the ICU/high dependency unit was recruited for the study. Among the various parameters analyzed, model for end-stage liver disease (MELD) score, Child-Pugh Turcot (CTP) score, albumin levels, total count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine aminotransferase (ALT), bilirubin, creatinine, urea, and absolute eosinophil count were statistically significant in predicting in-hospital mortality. The AUROC of AEC was plotted and found to be 0.881, which was better than other parameters for predicting in-hospital mortality. The cutoff of AEC by Youden’s index was 110 cells/cumm (sensitivity 91.3%, specificity 89%, positive predictive value 87.5%, and negative predictive value 93%) to predict in-hospital mortality. The AUROC of MELD was 0.78 with a cutoff of > 24 (sensitivity 89%, specificity 74.6%, positive predictive value 73%, and negative predictive value 89%) to predict the mortality. The odds ratio for predicting mortality was highest for absolute eosinophil count (92.75) followed by MELD (24.57), total count (20.475), CTP (10), and the presence of SIRS (9.08).

Conclusion

In critically ill cirrhosis patients with sepsis, AEC < 110 cells/cumm can predict in-hospital mortality.