White Blood Cell Counts, Alcoholism, and Cirrhosis in Pneumococcal Pneumonia

An elevated white blood cell (WBC) count is a characteristic finding in pneumococcal pneumonia. Very low WBC counts, occurring in some cases, are often associated with overwhelming pneumonia and have been attributed to alcohol-induced suppression of bone marrow. However, a systematic study of neutropenia, leukocytosis, alcohol ingestion, and cirrhosis in pneumococcal pneumonia has not been previously reported. Using a database of patients with pneumococcal pneumonia at our medical center, we extracted data on WBC counts at admission, differential counts, alcohol ingestion, and cirrhosis, and we related these to 7-day and 30-day mortality. White blood cell counts were 25000/mm in 40 (8.3%). Mortality at 7 days was 18.4% and 12.5%, respectively, 5-fold and 3-fold greater in patients with WBC 25000 than in those with WBC counts between 6000 and 25000 ( < .001). Increased band forms were not associated with a worse outcome ( = .12). Alcohol use and cirrhosis were not associated with WBC counts