Abstract
BackgroundLittle is known about the potential use of the eosinophil count as a predictive marker of bloodstream infection. In this study, we aimed to assess the reliability of eosinopenia as a predictive marker of bloodstream infection.MethodsThis retrospective cohort study was performed in the outpatient department and general internal medicine department of a tertiary university hospital in Japan. A total of 189 adult patients with at least 2 sets of blood cultures obtained during the period January 1–December 31, 2018, were included; those with the use of antibiotic therapy within 2 weeks prior to blood culture, steroid therapy, or a history of haematological cancer were excluded. The diagnostic accuracies of each univariate variable and the multivariable logistic regression models were assessed by calculating the areas under the receiver operating characteristic curves (AUROCs). The primary outcome was a positive blood culture indicating bloodstream infection.ResultsSevere eosinopenia (< 24.4 cells/mm3) alone yielded small but statistically significant overall predictive ability (AUROC: 0.648, 95% confidence interval (CI): 0.547–0.748, P < 0.05), and only moderate sensitivity (68, 95% CI: 46–85%) and specificity (62, 95% CI: 54–69%). The model comprising baseline variables (age, sex), the C-reactive protein level, and neutrophil count yielded an AUROC of 0.729, and further addition of eosinopenia yielded a slight improvement, with an AUROC of 0.758 (P < 0.05) and a statistically significant net reclassification improvement (NRI) (P = 0.003). However, the integrated discrimination index (IDI) (P = 0.284) remained non-significant.ConclusionsSevere eosinopenia can be considered an inexpensive marker of bloodstream infection, although of limited diagnostic accuracy, in a general internal medicine setting.
Highlights
Little is known about the potential use of the eosinophil count as a predictive marker of bloodstream infection
The presence of chills [7], the C-reactive protein (CRP) level [8, 9], and the quick Sequential (Sepsis-Related) Organ Failure Assessment score [10] have been identified as potential predictors of bloodstream infection, none has been determined to have adequate specificity and sensitivity
In this study we hypothesised that eosinopenia would be a reliable marker of bloodstream infection in adult patients treated in the general internal medicine department of a tertiary university hospital
Summary
Little is known about the potential use of the eosinophil count as a predictive marker of bloodstream infection. We aimed to assess the reliability of eosinopenia as a predictive marker of bloodstream infection. Some studies reported that the absence of peripheral blood eosinophils could not be used as a clinically reliable marker of Hirosawa et al BMC Infectious Diseases (2020) 20:85 bacteraemia in a hospital inpatient setting [12, 13], those studies included limited numbers of patients and were not restricted to general internal medicine departments. The potential usefulness of eosinopenia as a predictor of bloodstream infection in patients presenting or admitted to a general internal medicine department remains unclear. In this study we hypothesised that eosinopenia would be a reliable marker of bloodstream infection in adult patients treated in the general internal medicine department of a tertiary university hospital
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