Blood eosinophil count in the general population: typical values and potential confounders

Hartl, Sylvia; Breyer, Marie‐Kathrin; Burghuber, Otto Chris; Ofenheimer, Alina; Schrott, Andrea; Urban, Matthias; Agustí, Àlvar; Studnicka, Michael; Wouters, Emiel F.M.; Breyer‐Kohansal, Robab

doi:10.1183/13993003.01874-2019

Cited by 93 publications

(92 citation statements)

References 37 publications

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“…EOC in men and women showed significant differences both before and after dialysis (190.0 vs. 130.0/μL, p < 0.001; 239.3 vs. 161.9/μL, p < 0.001, respectively) in our study. This is consistent with studies of eosinophils in a healthy population, predialysis CKD patients, and HD patients, all of which reported EOC was higher in men than in women [11,25,26]. These results indicate that gender itself contributes to the different domain value of EOC instead of the effect caused by PD therapy, suggesting gender should be considered when defining the "normal" values of EOC.…”

Section: Discussionsupporting

confidence: 90%

Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Yang

Fan

et al. 2020

Int Arch Allergy Immunol

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Introduction: Eosinophilia (eosinophil fraction of leukocytes >5%), an indicative parameter for bioincompatibility in various circumstances, is well established in hemodialysis. However, change in eosinophil count (EOC) and its association with death-censored technique failure among peritoneal dialysis (PD) patients remain unclear. Methods: We compared eosinophils before and after PD initiation among 1,432 eligible continuous ambulatory PD patients regularly followed up in our PD center during 2007-2018. Risk factors of earlystage eosinophilia were examined by the logistic regression test. The relationship of early-stage eosinophilia and EOC with death-censored technique failure was examined using the Cox proportional hazards model for overall patients and for men and women separately. Results: After PD initiation, the EOC and percentage of patients with eosinophilia were significantly increased compared with baseline. Being male (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.55-3.31; p < 0.001) and higher EOC at baseline (100 cells/μL increase, OR: 1.62; 95% CI: 1.45-1.82; p < 0.001) were risk factors of early-stage eosinophilia after PD initiation. During follow-up, 204 death-censored technique failures were recorded. In fully adjusted models, each with 100 cells/μL increase in EOC, the adjusted hazard ratios (HRs) of technique failure were 1.11 (95% CI: 1.03-1.20; p = 0.009) in the whole cohort, 1.29 (95% CI: 1.10-1.51; p = 0.002) in women, and 1.07 (95% CI: 0.97-1.17; p = 0.196) in men. Eosinophilia was significantly associated with the risk of technique failure for women (HR: 2.24; 95% CI: 1.07-4.70; p = 0.033), which was especially significant for women aged <55 years (HR: 7.61; 95% CI: 1.88-30.90; p = 0.005). Conclusion: EOC was increased significantly after PD initiation, and increased numbers of eosinophils were associated with higher death-censored technique failure in PD patients, especially women.

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Section: Discussionsupporting

confidence: 90%

Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Yang

Fan

et al. 2020

Int Arch Allergy Immunol

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“…14 Mepolizumab is a humanized monoclonal antibody that binds to and inactivates interleukin-5, reducing blood eosinophils to normal levels. 15,16 Clinical trials of mepolizumab in severe eosinophilic asthma demonstrated reduced exacerbation frequency and improvements in disease burden, particularly in patients with higher blood eosinophil counts. [17][18][19][20][21] In COPD, the METREX and METREO trials investigated mepolizumab in patients with COPD who continued to experience exacerbations despite receiving maximal inhaled corticosteroid (ICS)-based triple maintenance therapy for ≥12 months prior to the study.…”

Section: Introductionmentioning

confidence: 99%

Mepolizumab for Eosinophil-Associated COPD: Analysis of METREX and METREO

Pavord¹,

Bafadhel²,

Sciurba³

et al. 2021

COPD

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Background A pre-specified meta-analysis of individual patient data from the 52-week METREX and METREO trials, which investigated mepolizumab for chronic obstructive pulmonary disease (COPD) in patients with blood eosinophil counts ≥150 cells/µL (screening) or ≥300 cells/µL (prior year) and frequent exacerbations, enables more robust characterization of mepolizumab efficacy in COPD and exploration of the relationship between blood eosinophil count and treatment responses. Methods In METREX (117106/NCT02105948) and METREO (117113/NCT02105961), randomized patients received mepolizumab or placebo added to existing inhaled corticosteroid (ICS)–based triple maintenance therapy. The annual rate of moderate/severe exacerbations (primary endpoint) was compared between subcutaneous (SC) mepolizumab 100 mg versus placebo (primary comparison of interest) and all doses (100 mg and 300 mg SC) versus placebo in patients with blood eosinophil counts ≥150 cells/µL at screening or ≥300 cells/µL in the prior year. Secondary/other endpoints included time to first moderate/severe exacerbation, exacerbations leading to emergency department visit/hospitalization and health-related quality of life (HRQoL). A predictive model of the relationship between screening blood eosinophil counts and exacerbation rates included data from all randomized patients. Results In total, 1510 patients were randomized in METREX and METREO and 1136 patients were included in the pre-specified meta-analysis. From the meta-analysis, mepolizumab 100 mg SC significantly reduced annual moderate/severe exacerbation rates versus placebo by 18% (rate ratio: 0.82; 95% confidence interval: 0.71, 0.95; p=0.006) and delayed time to first moderate/severe exacerbation (hazard ratio: 0.80 [0.68, 0.94]; p=0.006). Mepolizumab 100 mg SC versus placebo numerically reduced exacerbations leading to ED visits/hospitalization and improved HRQoL. A modelling approach demonstrated increasing efficacy for moderate/severe exacerbations with increasing screening blood eosinophil count; this relationship was more pronounced for exacerbations requiring oral corticosteroids (post hoc). The all-doses comparison had similar results. Conclusion Mepolizumab reduces exacerbations in patients with eosinophil-associated COPD. Results suggest that blood eosinophil counts (≥150 cells/µL at screening or ≥300 cells/µL in the prior year) allow for identification of patients with COPD who experience exacerbations while treated with maximal ICS-based triple maintenance therapy who are likely to benefit from mepolizumab.

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“…Eosinophilic inflammation (≥300 cells/μL) was observed in 41% of the study population overall and was most frequent in ACO (55%), intermediate in severe asthma (44%) and least frequent in COPD (29%). These frequencies of eosinophilia sit well above the ‘normal population’ prevalence of less than 5% 14 . Not surprisingly (based on recruitment strategy), all three diagnostic groups had similar high levels of disease burden.…”

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confidence: 73%