Table of Contents
ISRN Infectious Diseases
Volume 2013, Article ID 540948, 8 pages
http://dx.doi.org/10.5402/2013/540948
Clinical Study

Eosinopenia as a Prognostic Marker in Patients with Peritonitis

Department of Surgery, Government NSCB Medical College, Jabalpur 482003, India

Received 16 April 2012; Accepted 15 June 2012

Academic Editors: G. Calleri, E. Çiftçi, K. Peoc'H, M. R. Pourshafie, and F. Su

Copyright © 2013 T. S. Jagdeesh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Eosinopenia has been, recently, found to have strong association with inflammatory-syndrome-associated bacterial infectious diseases. This prompted us to investigate its use as a prognostic marker in perforation peritonitis patients. Methods. A prospective study of perforation peritonitis patients admitted to the surgical wards at a teaching hospital in Central India was conducted. jabalpur prognostic score (JPS, a simplified prognostic score for developing countries), C-reactive protein (mg/dL) levels, and absolute eosinophil counts (cells/cmm) were measured on admission. Their correlation with inpatient mortality was evaluated. Results. 94 consecutive patients were studied, peptic ( 𝑛 = 5 5 ) followed by ileal, colonic, and appendicular perforations were the commonest cause of peritonitis. 13/94 died; ileal perforations had the highest ( 𝑛 = 6 /34, 17.6%) mortality. When correlated with mortality, univariate analysis showed JPS, CRP, and AEC to be accurate prognostic markers ( 𝑃 < 0 . 0 0 0 0 1 ), while multivariate analysis showed only AEC to be accurate ( 𝑃 = 0 . 0 3 ). At a cut-off value of 8, JPS showed sensitivity of 77%, a specificity of 85.1%, positive predicted value (PPV) of 55%, negative predicted value (NPV) of 95%, and area under receiver operating curve (AUROC) was 0.86. CRP level, at a cut-off value of 7.4, yielded sensitivity of 92.3%, specificity of 79%, PPV of 41%, NPV of 98%, and AUROC was 0.93. At a cut-off value of 45, the sensitivity of the AEC was 92.3%, specificity of 92.5%, PPV 85%, NPV of 99%, and AUROC was 0.96. Discussion. Eosinopenia on admission is a prognostic marker of mortality in patients with peritonitis.