Annals of medicine · 2025
Low eosinophils and their dynamic as a predictor of death in patients with infections: a systematic review and meta-analysis of cohort studies.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Pinte Larisa, Dumitru Andra-Cristiana, Usurelu Andreea-Codruta, Niculae Cristian-Mihail, Draghici Anamaria, Cotet Marius Alexandru, Baicus Cristian
Аннотация
BACKGROUND: Eosinophils prognostic significance in predicting mortality has become particularly notable during the COVID-19 pandemic. We aimed to evaluate the prognostic value of peripheral low eosinophil (eosinopenia) with focus on their dynamics (eosinophil recovery) in patients with infections.
METHODS: We searched databases (MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library) and additional sources from inception to 1 December 2023. Cohort studies involving adult patients hospitalized with infections were evaluated using dual-reviewer methodology.
RESULTS: Out of 15,066 screened papers, 151 studies met the inclusion criteria, with 107 focused on COVID-19, 14 on sepsis, 9 on Clostridioides difficile, 6 on acute COPD exacerbations, and 17 on other infections. The majority of studies reported significantly lower admission eosinophil levels in non-survivors compared to survivors. Random-effects model meta-analysis showed mean eosinophil difference between deceased and survivors -15.31 (95% CI: -18.72 to -11.90) for COVID-19 and -44.6 (95% CI: -95.62 to 6.41) for sepsis (I2 > 90%). Mortality with eosinopenia showed low certainty of evidence for C. difficile (0 cells/mm³ cut-off: RR 2.35; 95% CI: 1.84-2.99) and very low for COVID-19 when considering different cut-offs (0 cells/mm³: RR 2.37; 95% CI: 1.86-3.01; 20 cells/mm³: RR 2.90; 95% CI: 1.59-5.28; 50 cells/mm³: RR 2.70; 95% CI: 1.33-5.49). Survivors generally showed an increase in eosinophil counts within the first 2-5 days of hospitalization, while the deceased had persistently low levels.
CONCLUSIONS: Eosinopenia, particularly the trajectory of eosinophil recovery, may serve as a cost-effective and accessible prognostic marker for mortality in patients with infections.
METHODS: We searched databases (MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library) and additional sources from inception to 1 December 2023. Cohort studies involving adult patients hospitalized with infections were evaluated using dual-reviewer methodology.
RESULTS: Out of 15,066 screened papers, 151 studies met the inclusion criteria, with 107 focused on COVID-19, 14 on sepsis, 9 on Clostridioides difficile, 6 on acute COPD exacerbations, and 17 on other infections. The majority of studies reported significantly lower admission eosinophil levels in non-survivors compared to survivors. Random-effects model meta-analysis showed mean eosinophil difference between deceased and survivors -15.31 (95% CI: -18.72 to -11.90) for COVID-19 and -44.6 (95% CI: -95.62 to 6.41) for sepsis (I2 > 90%). Mortality with eosinopenia showed low certainty of evidence for C. difficile (0 cells/mm³ cut-off: RR 2.35; 95% CI: 1.84-2.99) and very low for COVID-19 when considering different cut-offs (0 cells/mm³: RR 2.37; 95% CI: 1.86-3.01; 20 cells/mm³: RR 2.90; 95% CI: 1.59-5.28; 50 cells/mm³: RR 2.70; 95% CI: 1.33-5.49). Survivors generally showed an increase in eosinophil counts within the first 2-5 days of hospitalization, while the deceased had persistently low levels.
CONCLUSIONS: Eosinopenia, particularly the trajectory of eosinophil recovery, may serve as a cost-effective and accessible prognostic marker for mortality in patients with infections.