The biomarkers suPAR and blood eosinophils are associated with hospital readmissions and mortality in asthma – a retrospective cohort study

Abstract

IntroductionPrognostic biomarkers in asthma are needed. The biomarker soluble urokinase plasminogen activator receptor (suPAR) has been associated with asthma control and with prognosis in acutely admitted medical patients. We investigated if suPAR and blood eosinophil counts at the time of admission for asthma are associated with readmission and mortality.MethodsOur cohort comprised 1341 patients (median age 45.3, IQR 30.1–63.1) acutely admitted with a diagnosis of asthma to Hvidovre Hospital, Denmark (November 2013 to March 2017). Patients had suPAR and blood eosinophils measured at admission. Outcomes were 365-day readmission and all-cause mortality. Logistic regression analysis adjusted for age, sex, C-reactive protein, and Charlson comorbidity score was used to assess the association of the two biomarkers with readmission and all-cause mortality.ResultsCompared to event-free patients, patients who were either readmitted (n = 452, 42.3%) or died (n = 57, 5.3%) had significantly higher suPAR concentrations (p < 0.0001) and lower eosinophil counts (p = 0.0031) at admission. The highest odds of readmission or mortality were observed for patients in either the 4th suPAR quartile (p < 0.0001) or with eosinophil counts < 150 cells/μL at admission. Increasing levels of suPAR were associated with 365-day readmission (OR 1.3 [1.0–1.6]; p = 0.05) and mortality (OR 2.9 [1.7–5.1]; p = 0.0002). Eosinophil count > 300 cells/μL was significantly associated with lower odds of readmission (OR 0.64 [0.5–0.9]; p = 0.005) and lower mortality (OR 0.7 [0.6–0.9]; p = 0.0007).ConclusionsIn patients acutely admitted with asthma, elevated suPAR concentrations together with blood eosinophil count < 150 cells/μL at the time of hospital admission were associated with both 365-day all-cause readmission and mortality.

Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis

“…Eosinophils (EOSs) are key innate immune cells in host defence, [3] and they have been found to be associated with mortality in patients with chronic obstructive pulmonary disease (COPD) [4,5] and asthma. [6,7] The blood EOS counts are considered as a potential biomarker for identifying COPD patients at risk and as a reference for the usage of inhaled corticosteroids. [8] For ARDS, EOSs have been considered as an important immune response contributor, and they may be a diagnostic biomarker.…”

Blood Eosinophils and Mortality in Patients With Acute Respiratory Distress Syndrome: A Propensity Score Matching Analysis

“…However, the relationship between blood eosinophils and outcome has not been consistently clari ed in patients with asthma and those with COPD. In asthma, Price et al [7] reported that higher blood eosinophil counts are associated with more severe exacerbations and poorer asthma control, while Håkansson et al [6] found that a lower blood eosinophil count was related to both one-year readmission and mortality. In COPD, Casanova's longitudinal study [17] showed that patients with higher blood eosinophil counts for 2 years were more inclined to have a longer survival time.…”

“…Eosinophils are key innate immune cells in host defence [3], and they have been found to be associated with mortality in patients with chronic obstructive pulmonary disease (COPD) [4,5] and asthma [6,7]. The blood eosinophil count (EOS) is considered a potential biomarker for the identi cation of COPD patients at risk and as a reference for the usage of inhaled corticosteroids, as recommended by the GOLD 2019 guidelines [8].…”

Mepolizumab in the treatment of bronchial asthma in children

“…Провоспалительные медиаторы, секретируемые эозинофилами, вызывают повреждение эпителия, инициируя расширение сосудов, сокращение гладких мышц и повышенную секрецию слизи, что, в свою очередь, связано с повышенной гиперреактивностью дыхательных путей, симптомами БА и сужением дыхательных путей. Инициируя позднюю фазу воспаления, эозинофилы обеспечивают ремоделирование дыхательных путей [10,11]. Эозинофилы модулируют воспалительный процесс, продуцируя большое количество факторов, таких как токсические основные (щелочные) белки, липидные медиаторы, цитокины и супероксид-анионы.…”

“…Отмечено, что эозинофильная инфильтрация дыхательных путей сохраняется у детей с тяжелой формой БА, несмотря на использование высоких доз ингаляционных глюкокортикостероидов [12]. В то же время молекулярные механизмы, быстро и специфически регулирующие уровень эозинофилов, остаются малоизученными [10]. В активации эозинофилов ключевым фактором является интерлейкин-5 (ИЛ-5), поскольку рецепторы для этого цитокина экспрессируются преимущественно на эозинофилах [13].…”