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

<h4>Background</h4>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-defin...

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Autores principales:	Samuel H Belok, Nicholas A Bosch, Elizabeth S Klings, Allan J Walkey
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b8d2a69bb88544f5924220ccb5059a61
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spelling	oai:doaj.org-article:b8d2a69bb88544f5924220ccb5059a612021-12-02T20:05:17ZEvaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.1932-620310.1371/journal.pone.0252206https://doaj.org/article/b8d2a69bb88544f5924220ccb5059a612021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252206https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Samuel H BelokNicholas A BoschElizabeth S KlingsAllan J WalkeyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252206 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Samuel H Belok Nicholas A Bosch Elizabeth S Klings Allan J Walkey Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Samuel H Belok Nicholas A Bosch Elizabeth S Klings Allan J Walkey
author_facet	Samuel H Belok Nicholas A Bosch Elizabeth S Klings Allan J Walkey
author_sort	Samuel H Belok
title	Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
title_short	Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
title_full	Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
title_fullStr	Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
title_full_unstemmed	Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
title_sort	evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b8d2a69bb88544f5924220ccb5059a61
work_keys_str_mv	AT samuelhbelok evaluationofleukopeniaduringsepsisasamarkerofsepsisdefiningorgandysfunction AT nicholasabosch evaluationofleukopeniaduringsepsisasamarkerofsepsisdefiningorgandysfunction AT elizabethsklings evaluationofleukopeniaduringsepsisasamarkerofsepsisdefiningorgandysfunction AT allanjwalkey evaluationofleukopeniaduringsepsisasamarkerofsepsisdefiningorgandysfunction
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Evaluation of leukopenia during sepsis as a marker of sepsis-defining organ dysfunction.

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