Abstract
IntroductionInfection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm3) as a prognosis marker among older patients with suspected or confirmed bacterial infection.MethodsA retrospective study was performed from 1 January to 31 December 2018 among patients in a geriatrics ward suffering from a bacterial infection treated with antibiotics. Biomarker data including the eosinophil count, neutrophil count and C-reactive protein (CRP) were collected within 4 days after patient diagnosis. Persistent eosinopenia was defined as a consistent eosinophil count< 100/mm3 between Day 2 and Day 4. The association of biomarkers with 30-day hospital mortality in a multivariate analysis was assessed and their predictive ability using the area under the ROC curve (AUC) was compared.ResultsOur study included 197 patients with a mean age of 90 ± 6 years. A total of 36 patients (18%) died during their stay in hospital. The patients who died were more likely to have persistent eosinopenia in comparison to survivors (78% versus 34%, p < 0.001). In the multivariate analysis, persistent eosinopenia was associated with in-hospital mortality with an adjusted HR of 8.90 (95%CI 3.46–22.9). The AUC for eosinophil count, CRP and neutrophil count between Day 2 and Day 4 were 0.7650, 0.7130, and 0.698, respectively.ConclusionPersistent eosinopenia within 4 days of diagnosis of bacterial infection appeared to be a predictor of in-hospital mortality in older patients.
Highlights
Infection is one of the major causes of mortality and morbidity in older adults
Several biomarkers were evaluated on the day before treatment initiation to predict mortality among critically ill patients suffering from bacterial infection in an intensive care unit (ICU)
A total of 235 stays were eligible in this study and 197 patients were selected after the exclusion criteria
Summary
Infection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm3) as a prognosis marker among older patients with suspected or confirmed bacterial infection. Infection is one of the major causes of mortality and morbidity in older patients [1]. Used biological markers (biomarkers) such as C-reactive protein (CRP) and procalcitonin (PCT) lack discriminatory power to diagnose infection in older patients (> 65 years) [2, 3]. Jensen et al evaluated CRP value> 9 mg/L, leukocytes> 10 G/L and PCT > 1 ng/mL and showed that the only relevant parameter to identify patients at increased risk of all-cause mortality on day 90 was PCT in adults (median age 57 years) [4]. Clinical need for reliable biomarkers in older patients is important as they may present without classical signs and symptoms of infection [2]
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