Low Eosinophil Phenotype Predicts Noninvasive Mechanical Ventilation Use in Patients with Hospitalized Exacerbations of COPD

Abstract

Rationale Eosinophilic inflammation is related to the progression and outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Till now, few studies have focused on low EOS in AECOPD. Objective To reveal the clinical characteristics, therapeutic responses and prognosis of patients hospitalized of AECOPD with low EOS. Methods The electronic database of Zhongshan Hospital, Fudan University was used. Cohort 1 included 608 patients with hospitalized AECOPD. Study population 2 consisted of 166 patients with AECOPD admission at least twice. Impact of low EOS on NIMV treatment, length of hospital stays and 12-month AECOPD-related readmission were analyzed with multivariable logistic regression model. Thirty-five hospitalized AECOPD patients were prospectively recruited as cohort 3 to explore the association between EOS and other immune cells using Spearman correlation coefficient for ranked data. Results EOS level was suppressed on admission in AECOPD patients, and significantly improved after hospitalized treatment ( P < 0.05). For inflammatory markers, leucocytes, neutrophils and lactate dehydrogenase levels were higher, while lymphocytes, monocytes and interleukin-6 levels were lower in the low-EOS group than those in the non-low EOS group ( P < 0.05). Low EOS (EOS < 50 cells/μL) was an independent risk factor of NIMV use (OR = 1.86, 95% CI = 1.26 ~ 2.73). The EOS percentage was positively correlated with the T cell percentage ( r = 0.46, P < 0.05) and negatively correlated with the natural killer cell percentage ( r = −0.39, P < 0.05). The patients with low EOS had lower level of CD4 + T cell ( P < 0.05) than that of patients with non-low EOS. Conclusion Low EOS might be a stable phenotype in patients with hospitalized AECOPD and could be used to inform NIMV management, hyperinflammatory state and impaired immunity situation.

Eosinopenia as a Prognostic Biomarker for Noninvasive Ventilation Use in COPD Exacerbations

“…An interesting finding in our study was that respiratory dysfunction, as expressed by PaO 2 /FiO 2 (mmHg) and partially by arterial pH, differed among the groups with different blood eosinophil levels, showing again that subjects with lower blood eosinophil counts were characterized by more severe COPD exacerbation. Our findings are in agreement with a previous study [5], in which subjects with COPD exacerbation and low blood eosinophil numbers were characterized by higher levels of inflammatory biomarkers (leucocytes, neutrophils and lactate dehydrogenase levels) compared to subjects with higher blood eosinophil counts. In this study, a low blood eosinophil count was also an independent risk factor of the need for the use of NIV, a result that is also in accordance with our study.…”

“…The association of the levels of blood eosinophils during a COPD exacerbation with different disease outcomes has been described in previous studies [4,5,12], all showing that patients with lower blood eosinophil counts are at a greater risk. Since the severity of an exacerbation is associated with the severity of symptoms and the level of functional and respiratory impairment of patients [1], it is important to find inexpensive and available biomarkers for the early recognition of patients who will probably need closer monitoring or who will probably require early admission in intensive care units.…”

“…Eosinophilic airway inflammation accounts for approximately 25% of patients admitted to the hospital for a severe COPD exacerbation [3]. In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects [4,5]. During exacerbations of chronic obstructive pulmonary disease, eosinopenia has been proposed as a prognostic marker of adverse outcomes [6], and blood eosinophils have been used as a helpful biomarker for guiding treatment decisions in COPD subjects hospitalized due to disease exacerbation [7].…”

“…Hence, it is advisable to enhance the accuracy of early identification of subjects with COPD exacerbation who may need the application of NIV. Data from prospective studies have evaluated the predictive role of blood eosinophils in NIV of hospitalized COPD subjects [4,5]. According to the abovementioned findings, the objective of this post hoc analysis was to elucidate the effectiveness of blood eosinophils for predicting the need of NIV in COPD subjects hospitalized for a severe COPD exacerbation.…”

Blood Eosinophils and Clinical Outcomes in Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study

“…Non-eosinophilic AECOPD was additionally associated with higher rates of invasive mechanical ventilation, ICU admission, and a longer stay in the overall cohort and most of the subgroups studied here, which was in agreement with previous studies. 6 , 15 , 26–28 Non-eosinophilic AECOPD was not associated with longer hospital stay in the subgroup with pneumonia and ICU admission, and the reasons may be similar to the explanations for the lack of associations between blood eosinophils and in-hospital mortality in the subgroup with ICU admission. Further research is needed to explore the link between blood eosinophils and the duration of stay in the AECOPD patients with pneumonia and ICU admission.…”