Variability of blood eosinophil count and prognosis of COPD exacerbations

Martínez-Gestoso, Sandra; García-Sanz, María-Teresa; Calvo-Álvarez, Uxío; Doval-Oubiña, Liliana; Camba-Matos, Sandra; Salgado, Francisco-Javier; Muñoz, Xavier; Pérez-López-Corona, Purificación; González‐Barcala, Francisco‐Javier

doi:10.1080/07853890.2021.1949489

Cited by 19 publications

(17 citation statements)

References 49 publications

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“…The predicted value of eosinophils for the incidence and prognosis of future severe exacerbation was diverse, with either no relationship or a positive relationship reported. 18 , 40 , 41 Our findings are concordant with prior studies demonstrating a high prevalence (46%) of elevated eosinophil counts, defined as ≥2% of the total leukocyte count. 14 Many studies such as SUNSET, WISDOM and SPIROMICS have reported exacerbations correlating with blood eosinophils.…”

Section: Discussionsupporting

confidence: 91%

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Xu¹,

Sun²,

Zhao³

et al. 2022

COPD

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Purpose Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups. Patients and Methods Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters. Results The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, P <0.001), the COPD Assessment Test (CAT) score (20 vs 17, P <0.001), the blood eosinophil percentage (1.5 vs 2.0, P <0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥9 years), more symptoms (CAT ≥10), and lower blood eosinophils (Eos <2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations. Conclusion These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.

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Section: Discussionsupporting

confidence: 91%

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Xu¹,

Sun²,

Zhao³

et al. 2022

COPD

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“… 12 , 19 Some studies conducted in unselected AECOPD inpatients also revealed that patients with decreased eosinophils had a higher risk of all-cause hospital mortality. 6 , 11 , 20 , 21 In contrast, several researchers found that blood eosinophil counts were not associated with in-hospital mortality in unselected AECOPD inpatients, 13–15 and Chen et al discovered that on-admission eosinophils were not associated with in-hospital mortality in patients with AECOPD requiring ICU admission. 22 It is worth noting that most of these results are from single-center studies or with small sample sizes.…”

Section: Discussionmentioning

confidence: 98%

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

Pu¹,

Yi²,

Luo³

et al. 2023

COPD

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Purpose The prognostic value of blood eosinophils in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains controversial. This study aimed to evaluate whether blood eosinophils could predict in-hospital mortality and other adverse outcomes in inpatients with AECOPD. Methods The patients hospitalized for AECOPD were prospectively enrolled from ten medical centers in China. Peripheral blood eosinophils were detected on admission, and the patients were divided into eosinophilic and non-eosinophilic groups with 2% as the cutoff value. The primary outcome was all-cause in-hospital mortality. Results A total of 12,831 AECOPD inpatients were included. The non-eosinophilic group was associated with higher in-hospital mortality than the eosinophilic group in the overall cohort (1.8% vs 0.7%, P < 0.001), the subgroup with pneumonia (2.3% vs 0.9%, P = 0.016) or with respiratory failure (2.2% vs 1.1%, P = 0.009), but not in the subgroup with ICU admission (8.4% vs 4.5%, P = 0.080). The lack of association still remained even after adjusting for confounding factors in subgroup with ICU admission. Being consistent across the overall cohort and all subgroups, non-eosinophilic AECOPD was also related to greater rates of invasive mechanical ventilation (4.3% vs 1.3%, P < 0.001), ICU admission (8.9% vs 4.2%, P < 0.001), and, unexpectedly, systemic corticosteroid usage (45.3% vs 31.7%, P < 0.001). Non-eosinophilic AECOPD was associated with longer hospital stay in the overall cohort and subgroup with respiratory failure (both P < 0.001) but not in those with pneumonia (P = 0.341) or ICU admission (P = 0.934). Conclusion Peripheral blood eosinophils on admission may be used as an effective biomarker to predict in-hospital mortality in most AECOPD inpatients, but not in patients admitted into ICU. Eosinophil-guided corticosteroid therapy should be further studied to better guide the administration of corticosteroids in clinical practice.

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“…In previous studies, eosinophilic AECOPD patients included those in the HL group, thereby limiting the possibility of finding the potential significant associations. Other studies investigating the variability of BEC and exacerbation risk were carried out mainly in stable COPD patients [ 7 , 8 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Stability of blood eosinophils in acute exacerbation of chronic obstructive pulmonary disease and its relationship to clinical outcomes: a prospective cohort study

et al. 2021

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Background The clinical value of blood eosinophils and their stability in chronic obstructive pulmonary disease (COPD) remains controversial. There are limited studies on association between the stability of blood eosinophils in acute exacerbation of COPD (AECOPD) and clinical outcomes. This study aimed to evaluate the stability of blood eosinophils in hospitalized AECOPD and its relationship to clinical outcomes. Methods This prospective observational study recruited patients hospitalized with AECOPD from November 2016 to July 2020. The eligible patients were divided into four groups according to their blood eosinophil counts at admission and discharge: persistently < 300 cells/μl (LL), < 300 cells/μl at admission but ≥ 300 cells/µl at discharge (LH), ≥ 300 cells/μl at admission but < 300 cells/µl at discharge (HL), and persistently ≥ 300 cells/μl (HH). Cox hazard analyses were used to study the association between eosinophil changes and exacerbations or mortality. Results In 530 patients included, 90 (17.0%) had a high blood eosinophil count (BEC) ≥ 300 cells/µl at admission but 32 (35.6%) of them showed a decreased BEC at discharge. The proportions and distribution for group LL, LH, HL, and HH were 381 (71.9%), 59 (11.1%), 32 (6.0%), and 58 (10.9%), respectively. During hospitalization, the LH group had a higher C-reactive protein level, higher rate of intensive care unit (ICU) admission, and higher total cost. The length of hospital stay of the LH group was longer compared with group LL, HL, or HH (P = 0.002, 0.017, and 0.001, respectively). During a follow-up of 12 months, the HH group was associated with a higher risk of moderate-to-severe exacerbations compared to the LL group (hazard ratio 2.00, 95% confidence interval 1.30–3.08, P = 0.002). Eosinophil changes had no significant association with mortality at 12 months. Sensitivity analyses in patients without asthma and without use of systemic corticosteroids prior to admission did not alter the results. Conclusions More attention should be paid to the LH group when evaluating the short-term prognosis of AECOPD. A persistently high BEC was a risk factor for long-term exacerbations. Eosinophil changes during hospitalization could help to predict outcomes.

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Variability of blood eosinophil count and prognosis of COPD exacerbations

Cited by 19 publications

References 49 publications

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study

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

Stability of blood eosinophils in acute exacerbation of chronic obstructive pulmonary disease and its relationship to clinical outcomes: a prospective cohort study

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