What question did this study set out to answer?

This research aims to investigate the prognostic significance of eosinopenia in patients with severe community-acquired pneumonia admitted to the ICU.

March 26, 2026Open Access

Eosinopenia and prognosis in severe community-acquired pneumonia

Key Points

This research aims to investigate the prognostic significance of eosinopenia in patients with severe community-acquired pneumonia admitted to the ICU.
Retrospective analysis of 496 ICU patients with severe pneumonia
Stratification based on eosinopenia at admission
Comparison of clinical characteristics, laboratory data, and outcomes between eosinopenic and non-eosinopenic groups
Identification of factors associated with 30-day mortality using multivariable Cox regression
Assessment of eosinophil counts and severity scores using ROC curves
Eosinopenia was present in 33% of patients and was linked to higher in-hospital and 30-day mortality.
Patients with eosinopenia required more invasive mechanical ventilation (58% vs. 45%) and experienced more pleural effusions (30% vs. 19%).
Eosinopenia was found to be an independent predictor of 30-day mortality (HR 1.95).
Eosinophil count alone showed poor discrimination for mortality (AUC 0.562), while CURB-65Eos had a moderate performance.

Abstract

Eosinopenia has been reported as a marker of severity in infections, but its prognostic value in patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) is unclear. We retrospectively analyzed 496 patients with severe CAP admitted to the ICU and stratified them according to the presence of eosinopenia on admission. We compared clinical characteristics, laboratory data, microbiological etiology, treatment, complications, and outcomes between groups. Independent factors associated with 30-day mortality were identified using multivariable Cox regression. Discriminative performance of eosinophil count, severity scores (CRB-65, CURB-65, PSI), and a modified CURB-65 incorporating eosinopenia (CURB-65Eos) were assessed using ROC curves. Eosinopenia was present in 163/496 patients (33%). Age and most comorbidities were similar between groups. Compared with non-eosinopenic patients, eosinopenic patients had lower leukocyte, neutrophil, and lymphocyte counts and more frequent viral or polymicrobial infections. They more often required invasive mechanical ventilation (58% vs. 45%, p = 0.009) and developed pleural effusion (30% vs. 19%, p = 0.008). In-hospital and 30-day mortality were higher in the eosinopenia group (21% vs. 13%, p = 0.036; 20% vs. 12%, p = 0.022). In the predefined multivariable Cox model, eosinopenia was independently associated with increased 30-day mortality (HR 1.95; 95% CI 1.19 to 3.20; p = 0.008). Eosinophil counts alone showed poor discrimination for 30-day mortality (AUC 0.562), while established severity scores performed moderately. CURB-65Eos showed a numerical but nonsignificant improvement over CURB-65. Eosinopenia is common in patients with severe CAP admitted to the ICU and is independently associated with increased 30-day mortality. It may serve as a simple and inexpensive biomarker for the early identification of high-risk patients and could complement established severity scores to support closer monitoring and earlier escalation of care.

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Cite This Study

Cilloniz et al. (Wed,) studied this question.

synapsesocial.com/papers/69c4cd49fdc3bde448919663 https://doi.org/https://doi.org/10.1186/s41479-026-00196-0

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