Eosinopenia, an early marker of increased mortality in critically ill medical patients
Eosinopenia, an early marker of increased mortality in critically ill medical patients
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DOI：
10.1007/s00134-011-2170-z
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发表时间：
2011-07-01
影响因子：
38.9
通讯作者：
Abouqal, Redouane
中科院分区：
文献类型：
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作者：
Abidi, Khalid;Belayachi, Jihane;Abouqal, Redouane
炎症标志物可能在预测重症监护室（ICU）患者疾病严重程度方面发挥作用。本研究的目的是确定是否低嗜酸性粒细胞计数可以预测28天的死亡率在内科ICU。一个前瞻性研究超过4个月的时间。为了评估嗜酸性粒细胞计数提供的预后信息，我们比较了从ICU入院到第七天存活和死亡患者之间嗜酸性粒细胞计数的变化。使用Younden指数选择最佳截止值，以识别具有高死亡风险的患者。患者结局为28天死亡率。共有200例患者符合条件。总体28天ICU死亡率为28%（n = 56）。在ICU入院时，存活者[30个细胞/mmA（3）;四分位距（IQR），0-100个细胞/mmA（3）]和非存活者[0个细胞/mmA（3）; IQR，0-30个细胞/mmA（3）; P = 0.004]的嗜酸性粒细胞计数中位数存在显著差异。从入院到第七天，死亡者的嗜酸性粒细胞绝对计数仍显着降低。嗜酸性粒细胞减少< 40 cells/mm 3的患者28天死亡率显著较高（P = 0.011）。采用时间依赖性协变量的考克斯模型进行的多变量分析表明，嗜酸性粒细胞计数< 40个细胞/mm 3 [风险比（HR），1.85; 95%置信区间（CI），1.01-3.42; P = 0.046]，急性生理学和慢性健康评估（APACHE）II评分高（HR，1.08; 95% CI，1.01-1.14; P = 0.014），序贯器官衰竭评估（SOFA）评分较高（HR，1.14; 95% CI，1.03-1.25; P = 0.008），并使用机械通气（HR，27.48; 95% CI，12.12-62.28; P < 0.001）是28天所有本研究提示，在入院时和最初7天内使用嗜酸性粒细胞计数作为内科ICU死亡率的预后标志物是可能的。
Inflammatory markers may have a role in predicting severity of illness of intensive care unit (ICU) patients. The aim of this study is to determine whether low eosinophil count can predict 28-day mortality in medical ICU.A prospective study over a 4-month period. To evaluate the prognosis information provided by eosinophil count, we compared the variations in eosinophil count from ICU admission to seventh day between patients who survived and those who died. The best cutoff value was chosen using Younden's index for identification of patients with high risk of mortality. The patient outcome was 28-day mortality.A total of 200 patients were eligible. Overall 28-day ICU mortality was 28% (n = 56). At ICU admission, the median eosinophil count was significantly different in survivors [30 cells/mmA(3); interquartile range (IQR), 0-100 cells/mmA(3)] and nonsurvivors (0 cells/mmA(3); IQR, 0-30 cells/mmA(3); P = 0.004). Absolute eosinophil counts remained significantly lower in nonsurvivors from admission to seventh day. The 28-day mortality was significantly higher in patients with eosinopenia < 40 cells/mm(3) (P = 0.011). Multivariate analysis by Cox model with time-dependent covariates demonstrated that eosinophil count < 40 cells/mm(3) [hazard ratio (HR), 1.85; 95% confidence interval (CI), 1.01-3.42; P = 0.046], high Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR, 1.08; 95% CI, 1.01-1.14; P = 0.014), high Sequential Organ Failure Assessment (SOFA) score (HR, 1.14; 95% CI, 1.03-1.25; P = 0.008), and use of mechanical ventilation (HR, 27.48; 95% CI, 12.12-62.28; P < 0.001) were independent predictors of 28-day all-cause mortality.This study suggests the possibility to use eosinophil cell count at admission and during the first 7 days as a prognosis marker of mortality in medical ICU.