Comparison of the clinical characteristics and treatment outcomes of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD

Abstract

PurposeWe compared the clinical characteristics and treatment outcomes of patients with eosinophilic and neutrophilic COPD exacerbations requiring hospital admission.Patients and methodsThis was a retrospective multicenter study performed between January 2010 and December 2014. In all, 1,688 COPD patients admitted via the outpatient clinics or emergency departments of six university hospitals were enrolled. The patients were grouped by complete blood counts: eosinophilic group, >2% peripheral blood eosinophils, and neutrophilic group, >65% peripheral blood neutrophils or >11,000 leukocytes/mL. The patients with radiographic evidence of pneumonia at the time of admission, those with lung cancer, those admitted for treatment of other medical problems, and those who chronically used steroids were excluded.ResultsA total of 605 patients hospitalized with COPD exacerbations (177 eosinophilic and 380 neutrophilic) were included. Pulmonary functions, including the forced expiratory volume in 1 second and forced vital capacity, were better in patients with eosinophilic exacerbations. Treatment outcomes, including the rate of admission to the intensive care unit and mortality, were poorer in patients with neutrophilic exacerbations (4.5% vs 12.4%, P=0.004; 1.1% vs 4.5%, P=0.043, respectively). Congestive heart failure (odds ratio [OR] =3.40, 95% confidence interval [CI]: 1.28–9.01) and neutrophilic exacerbation (OR = 2.81, 95% CI: 1.21–6.52) were independent risk factors for intensive care unit admission.ConclusionCOPD patients with neutrophilic exacerbations experienced worse clinical outcomes than did those with eosinophilic exacerbations. The peripheral blood eosinophil count may be a useful predictor of clinical progress during hospitalization of COPD patients with acute exacerbations.

<p>Peripheral Blood Eosinophil as a Biomarker in Outcomes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

“…18 Similarly, Kang suggested better pulmonary function, lower admissions to the ICU, and mortality in a group with eosinophil levels less than 2%. 19 Duman et al reported that shorter hospital stays and lower readmission rates were found in the group with eosinophilia, but no differences were found in six-month mortality. 20 Patients with AECOPD, and low (< 50/µL) eosinophil were strongly associated with longer median hospital stay (7 vs 4 days, P < 0.001), and lower 12-month survival (82.4% vs 90.7%, P < 0.028) than patients with high (> 150/µL) eosinophil counts.…”

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

“…62 Another retrospective Chinese case-control study 63 on hospitalized COPD patients also found no differences in WBC, neutrophil, and CRP levels between AECOPD þ CAP and AECOPD groups, although the percentage of neutrophils increased from baseline. Generally considered a marker of bacterial infection, 64 this increase was shown to be a protective factor for pneumonia, probably due to the early use of antibiotics that delayed progression in patients with AECOPD. 63 Of note, the level of D-dimer was higher for patients with AECOPD þ CAP and predicted the presence of CAP, 63 suggesting its potential utility as a diagnostic tool for identifying infection.…”

The Importance of Neutrophil to Lymphocyte Ratio and Peripheral Blood Eosinophilia in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: Recent Studies

“…Hye et al investigated the importance of inflammatory markers to AECOPD pa-Open Journal of Respiratory Diseases tients required to hospital admission. [20] They conducted a retrospective study enrolled 1688 COPD subjects admitted to the outpatient and the emergency departments ( Table 2). According to their complete blood count, the patients were grouped into eosinophilic group (peripheral blood eosinophilia "PBE" > 2%) and neutrophilic group (Peripheral blood neutrophils "PBN" > 650 or leukocytes > 11.000/ml) and their clinical characteristics and treatment outcomes were compared.…”