PROGNOSTIC-SIGNIFICANCE OF THE NEUTROPHIL COUNT IN IMMUNOCOMPETENT PATIENTS WITH BACTEREMIA

To examine the prevalence of neutropaenia in immunocompetent, bacterae mic patients, and whether it carries an independent risk for mortality , we surveyed 2096 bacteraemic patients without malignant diseases, an d who were not receiving cytotoxic drugs. The granulocyte count on the day of the first positive blood culture was <1 x 10(9) cells/l in 33 patients (1.7%, group 1); 1.0-4.0 x 10(9) cells/l in 154 patients (7.9 %, group 2); 4.0-8.0 x 10(9) cells/l in 564 patients (29%, group 3); 8 .0-20.0 x 10(9) cells/l in 1034 patients (53%, group 4); and >20.0 x 1 0(9) cells/l in 163 patients (8.4%, group 5). The mortality rates in t he five groups were 39.4%, 18.8%, 18.1%, 25.7% and 25.8%, respectively (p=0.0001). The main pathogens in group 1 were Staphylococcus aureus in 25% of patients and Pseudomonas sp, in 23%. Mortality in group 1 pa tients was higher than in the other patients (odds ratio 1.4, 95% CI 1 .1-1.9]. Mortality was also significantly higher in group 2 patients w ith high blood urea nitrogen. The percentage of neutropaenic, septic p atients without known risk factors for neutropaenia is small, but thei r mortality is high. Overall mortality in patients with relative neutr opaenia (1.0-4.0 x 10(9) cells/l) is low, but a subgroup of patients w ith high blood urea nitrogen is at considerable risk for a fatal outco me. High leucocyte counts are also a marker of increased risk for mort ality, but this association is not an independent prognostic factor.