Purpose To assess the relationship between the duration of systemic corticosteroid therapy and blood eosinophil counts in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Patients and Methods This study included 292 patients with acute COPD exacerbations treated with daily intravenous injections of 40 mg/day methylprednisolone at the Department of Respiratory Medicine, Anhui No.2 Provincial People’s Hospital, Hefei, China. The study subjects were divided into two groups – (1) a low-dose group (n = 136) that included patients treated with methylprednisolone for less than or equal to 5 days and (2) a high-dose group (n = 156) that included patients treated with methylprednisolone for more than 5 days. The blood eosinophil counts were analyzed for both the patient groups, and an optimal cut-off value was calculated to distinguish between the two groups. The study endpoints were readmission or deaths within 30 days or 180 days and re-infections within 90 days after hospital discharge. Results The mean blood eosinophil counts in the low- and high-dose groups were 0.15 × 10 9 /L (0.11–0.23 × 10 9 /L) and 0.08 × 10 9 /L (0.04–0.12 × 10 9 /L), respectively ( P < 0.01). Receiver operating characteristic (ROC) curve analysis showed that the cut-off value for the blood eosinophils to distinguish the two patient groups was 0.115 × 10 9 /L with a sensitivity and specificity of 72.8% and 72.4%, respectively. The number of readmissions between the two groups at 30 days and 180 days after hospital discharge did not show any significant differences ( P = 0.292, P = 0.398). The follow-up data showed significantly higher rate of re-infections in the high-dose group (24/136) within 90 days after hospital discharge compared to the low-dose group (9/156) ( P = 0.018). Conclusion In patients with acute exacerbations of COPD, blood eosinophil counts of ≥0.115 × 10 9 /L were associated with effective response to corticosteroid therapy in ≤5 days.
Background:The relationship between increased blood eosinophils (EOS) and the prognosis of patients with chronic obstructive pulmonary disease (COPD) remains controversial. We aimed to explore the stability of blood eosinophils in patients with multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) over a 1-year period and its relationship with readmission rates and mortality. Methods: Prospectively include patients with at least 2 hospitalizations for AECOPD in 1 year between June 2019 and December 2021. Using 150 cells/ul as the cut-off value, the study population was divided into EOS, non-EOS, and fluctuating groups based on the longitudinal stability of blood EOS. The relationship between blood EOS and readmission rate and mortality was analyzed according to the 6-month follow-up after hospital discharge. Results: A total of 202 patients were included. 48, 108, and 46 patients were in the EOS, non-EOS, and fluctuating groups, respectively. The stability of blood EOS at 1 year was 77.2%. The risk of death was lower in the EOS group compared to the non-EOS group (HR=0.323, 95% CI 0.113-0.930, P =0.036). The risk of readmission was lower in both the EOS group (HR=0.486, 95% CI 0.256-0.923, P =0.027) and the non-EOS group (HR=0.575, 95% CI 0.347-0.954, P = 0.032) than in the fluctuating group. Conclusion:The blood EOS of COPD patients is relatively stable over 1 year. Patients with consistently high blood EOS had a lower risk of all-cause mortality after discharge; patients with fluctuating blood EOS had a higher risk of readmission.
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