Role of the eosinophil count in discriminating the severity of community-acquired pneumonia in HIV-infected patients.

Abstract

Abidi and colleagues recently reported that eosinopenia constitutes a good diagnostic marker in distinguishing between noninfection and infection, but is a moderate marker in discriminating between systemic inflammatory response syndrome and infection in newly admitted critically ill patients [1]. They propose that eosinopenia may become a helpful clinical tool in intensive care unit (ICU) practices. They included different types of severe infections, however, and therefore the utility of eosinopenia for a particular kind of infection is not approached. We would like to describe our experience with a homogeneous group of HIV-infected patients suffering from community-acquired pneumonia (CAP), a severe clinical condition that sometimes can lead the patient to the ICU. We consecutively included 137 HIV-infected patients with a firm diagnosis of CAP based on Infectious Diseases Society of America criteria, whose clinical, analytical and outcome data were prospectively recorded. We split our series into different groups depending on the patient requiring ICU admission (n = 29) or not requiring ICU admission (n = 108), and depending on inhospital patient survival (n = 132) or inhospital death (n = 5). The results are presented in Table ​Table1.1. As can be seen, eosinopenia was not associated with a higher ICU admission rate or with higher mortality. Accordingly, we believe that the total eosinophil count and/or eosinopenia have little (if any) value in predicting the severity of CAP in HIV-infected patients. Table 1 Relationship between some analytical parameters and severity of community-acquired pneumonia in HIV-infected patientsa From the emergency department point of view – departments that usually are overcrowded [2] – any tool that allows the physicians to better approach the severity of the infections in general, and the severity of the HIV-infected patients developing CAP in particular, would be welcomed [3,4]. Eosinophils seem to fail to fulfil this commitment, while other classic analytical markers, such as the total leukocyte count or C-reactive protein values, remain with greater prognostic value [5].