Leukocyte differential for acute abdominal pain in adults

Abdominal pain is a common symptom underlying a variety of disorders with different prognoses. Neutrophilia or lymphopenia have been used as prognostic markers in several stress- or infection-mediated disorders. We studied the clinical relevance of the leukocyte differential in the initial workup of adult patients presenting with abdominal pain.

We reviewed all leukocyte differentials and medical records of 441 consecutive patients admitted for abdominal pain in an emergency department. Patients were matched by age and sex with controls and were assigned to 4 groups: functional disorders (group FUN), infectious medical disorders (group INF) and noninfectious medical disorders (group MED), and surgical disorders (group SUR). Patients of groups INF and SUR were pooled into group INF+SUR to predict severe illness, and this group was compared with others with nonsevere illness.

All patients exhibited neutrophilia, along with a neutrophil count that increased with illness severity. Lymphopenia, eosinopenia, and basopenia characterized patients of group INF+SUR. Neutrophilia, eosinopenia, and lymphopenia were independent predictors of the most severely affected patients. The association of a neutrophil count >9.0 × 10⁹/L with lymphopenia (<1.4 × 10⁹L) and eosinopenia (<0.04 × 10⁹/L) had a specificity of 94.9% (95% confidence interval, 91.2%-97.1%) for inclusion in group INF+SUR, although with a low sensitivity (27.5%).

Lymphocyte, eosinophil, and neutrophil counts should be considered in medical admissions of adults with abdominal pain. Lymphopenia associated with eosinopenia and significant neutrophilia is highly suggestive of a more severe illness.