Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction

Abstract

Background Although both leukocytosis and leukopenia have been considered Systemic Inflammatory Response Syndrome criteria, leukopenia is not generally considered a normal response to infection. We sought to evaluate the prognostic validity of leukopenia as a sign of sepsis-defining hematological organ dysfunction within the Sepsis-3 framework. We hypothesized that leukopenia is associated with higher risk of mortality than leukocytosis among patients with suspected infection. Methods We performed a retrospective cohort study using the Medical Information Mart v1.4 in Intensive Care-III database. Multivariable regression models were used to evaluate the association between leukopenia and mortality in patients with suspected infection defined by Sepsis-3. Results We identified 5,909 ICU patients with suspected infection; 250 (4.2%) had leukopenia. Leukopenia was associated with increased in-hospital mortality compared with leukocytosis (OR, 1.5; 95% CI 1.1–1.9). After adjusting for demographics and comorbidities in the Sepsis-3 consensus model, leukopenia remained associated with increased risk of mortality compared with leukocytosis (OR 1.6, 95% CI 1.2–2.2). Further adjustment for the platelet component of the SOFA attenuated the association between leukopenia and mortality (OR decreased from 1.5 to 1.1). However, 83 (1.4%) of patients had leukopenia without thrombocytopenia and 14 had leukopenia prior to thrombocytopenia. Conclusions Among ICU patients with suspected infection, leukopenia was associated with increased risk of death compared with leukocytosis. Due to correlation with thrombocytopenia, leukopenia did not independently improve the prognostic validity of SOFA; however, leukopenia may present as a sign of sepsis prior to thrombocytopenia in a small subset of patients.

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

“…Noteworthy, the increase of neutrophils, also known as neutrophilia, can occur in response to a stressor, including physical and emotional stress, as well as smoking [41]. Also, chronic disorders, such as inflammatory bowel disease, rheumatic disease, and hepatitis, as well as congenital disorders, such as Down syndrome, are characterized by baseline neutrophilia [42]. Finally, paraphysiological conditions, such as pregnancy and obesity, could be associated with acute to chronic neutrophilia [43].…”

Mean platelet volume is useful for predicting weaning failure: a retrospective, observational study

“…Leukocyte level was also an independent predictor of weaning failure in this study, however, by comparing the AUC between MPV and leukocyte count, we concluded that leukocyte was an inferior predictive marker of weaning failure. It is known that sepsis or severe infection could cause either leukocytosis or leukopenia [ 29 ]. Many patients presented a normal leukocyte count.…”

Inhibition of Matrix Metalloproteinase-8 Protects Against Sepsis Serum Mediated Leukocyte Adhesion

“…The deleterious accumulation of neutrophils in the endothelial vasculature of organs leads to collateral tissue damage and, ultimately, multiple-organ failure ( 40 ). Leukopenia, which is probably caused by the over-adhesion of leukocytes to the endothelium, is detrimental to the prognosis of sepsis ( 41 ). In addition, endothelial function is also impaired by the released granules after adhesion and infiltration of leukocytes on the endothelium, which accelerates organ dysfunction ( 42 , 43 ).…”