Silva João M, Costa Artur M, Tuna Célia, Gonçalves Renato, Ferreira Sara, Belém Francisco, Evangelista Maria C, Ascensão Margarida
Interno de Formação Específica em Medicina Interna.
Assistente Hospitalar em Medicina Interna.
Porto Biomed J. 2020 Nov 11;5(6):e084. doi: 10.1097/j.pbj.0000000000000084. eCollection 2020 Nov-Dec.
The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them.
Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered.Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3.
A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections.Infected patients had fewer eosinophils than uninfected patients (15.8 ± 42 vs 71.1 ± 159 cell/mm; < .001). An eosinophil count at admission ≤69 cell/mm had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682-0.822) for the presence of infection. Eosinophil count of >77 cells/mm had a negative likelihood ratio of 0.16.
Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm was the most accurate in predicting infection. Eosinophil count >77 cells/mm was a good predictor of absence of infection.
在内科病房中识别感染至关重要，但并非总是一目了然。嗜酸性粒细胞减少已被提议作为感染的一个标志物，但尚未确定用于预测的具体临界值。我们旨在评估感染患者与未感染患者的嗜酸性粒细胞计数是否存在差异，如果存在差异，找出区分两者的最佳临界值。
进行横断面观察性研究，分析连续两个月入住内科的所有患者。对临床、实验室和影像学数据进行分析。入院时的感染定义为存在微生物分离或提示性的临床、实验室和/或影像学表现。入院前8天使用抗生素、存在免疫抑制、血液系统肿瘤、寄生虫或真菌感染为排除标准。若患者多次入院，仅考虑首次入院情况。通过受试者工作特征曲线确定嗜酸性粒细胞、白细胞、中性粒细胞和C反应蛋白的敏感性和特异性值。使用IBM SPSS Statistics® v25和MedCalc Statistical Software® v19.2.3进行统计分析。
共评估了323次住院病例，每个病例对应不同患者。排除115例患者。共纳入208例患者，其中62.0%（n = 129）入院时感染。10例患者有多重感染。感染患者的嗜酸性粒细胞少于未感染患者（15.8 ± 42对71.1 ± 159个细胞/mm³；P <.001）。入院时嗜酸性粒细胞计数≤69个细胞/mm³对感染存在的敏感性为89.1%，特异性为54.4%（曲线下面积0.752；95%置信区间0.682 - 0.822）。嗜酸性粒细胞计数>77个细胞/mm³的阴性似然比为0.16。
感染患者的嗜酸性粒细胞计数显著低于未感染患者。69个细胞/mm³的临界值在预测感染方面最准确。嗜酸性粒细胞计数>77个细胞/mm³是无感染的良好预测指标。
