Association between blood eosinophil count and bacterial infection and clinical outcomes in patients with severe exacerbations of chronic obstructive pulmonary disease

Differences in Blood Eosinophil Level During Stable Disease and During Exacerbation of COPD and Exacerbation Risks

BACKGROUND

Although blood eosinophil count (BEC) has been extensively studied as a biomarker in chronic obstructive pulmonary disease (COPD), there remain challenges and controversy in using a single reading. It has not been determined whether the difference in BEC between baseline and that during an acute exacerbation of COPD (AECOPD) has any role in predicting subsequent AECOPD.

METHODS

A prospective study was conducted to investigate the possible role of differences in BEC from baseline to that during AECOPD to predict future AECOPD risk. The BEC difference was expressed as absolute eosinophil difference: BEC at index moderate-to-severe exacerbation (Ei) - baseline BEC (E0).

RESULTS

Among 348 Chinese patients with COPD, 158 who experienced an index moderate-to-severe AECOPD were analyzed. Using the cut-off of 105 cells/µL for absolute eosinophil difference as determined by receiver operating characteristic (ROC) analysis, patients with absolute eosinophil difference ≥ 105 cells/µL had a shorter time to subsequent AECOPD with adjusted hazard ratio (aHR) of 1.68 (95% CI = 1.02-2.74; p = 0.040). They also had a higher annual number of subsequent AECOPD (2.49 ± 2.84/year vs 1.58 ± 2.44/year, p = 0.023). Similar findings were shown in the subgroup with stable-state baseline BEC < 300 cells/µL.

CONCLUSION

Greater difference in BEC between baseline and upon moderate-to-severe AECOPD might be associated with shorter time to next AECOPD, as well as more episodes of subsequent AECOPD.

Impact of blood eosinophil count on clinical outcomes in hospitalized Syrian patients with COPD exacerbation

OBJECTIVE

In this multicenter retrospective study, we evaluated the prognostic role of blood eosinophil count on clinical outcomes in hospitalized patients with exacerbations of chronic obstructive pulmonary disease (COPD).

METHODS

We included patients aged 20 to 90 years with a COPD diagnosis. Patients were divided into groups with blood eosinophil count ≤300 or >300 cells/μL and then further classified into 1-99, 100-300, or >300 cells/μL. We compared sociodemographic features and clinical outcomes between groups and identified risk factors associated with mortality in hospitalized patients with COPD and blood eosinophil count ≤300 cells/μL.

RESULTS

In total, 217 patients were included (82% men, average age 64.3±10.3 years). Patients with eosinophil counts ≤300 cells/μL had significantly longer hospital stays, more admissions to the intensive care unit (22.2% vs. 4.3%), and more frequent mechanical ventilation (21.6% vs. 4.3%) than those with eosinophil counts >300 cells/μL. Mortality only occurred in the group with ≤300 cells/μL; patients with COPD who had eosinophil counts >300 cells/μL had significantly better survival rates (17.0% vs. 0%).

CONCLUSION

High blood eosinophil counts at admission were associated with improved short-term outcomes. Our findings reveal the importance of considering eosinophil counts in clinical decision-making to manage hospitalized patients with COPD.

The association between blood eosinophils and clinical outcome of acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis

OBJECTIVES

Studies have shown an association between eosinophilia and clinical outcomes in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, contradictory findings exist. Our study aims to systematically evaluate the association between elevated peripheral blood eosinophils and clinical outcome of patients with AECOPD.

METHODS

An electronic search was conducted for relevant studies published from database inception to February 28, 2023, on PubMed, EMBASE, Cochrane Library, and Web of Science. The analysis covered studies on the correlation between EOS AECOPD and mortality, hospital stay duration, readmission and hospitalization rates, and invasive mechanical ventilation. Where applicable, relative risk (RR) and weighted mean difference (WMD) were extracted, pooled, and assessed using meta-analysis. Sensitivity analysis was performed to explore the source of heterogeneity.

RESULTS

Fifteen high-quality studies including 14 cohort studies and one case-control study were included in the meta-analysis. Compared with non-eosinophilic AECOPD patients, those with eosinophilic AECOPD had a lower risk of mortality (RR = 0.65, 95 % confidence interval [CI] 0.54, 0.77, P < 0.001), shorter length of hospital stay (WMD = -1.56, 95%CI -2.16, -0.96, P < 0.001), and higher readmission rate (RR = 1.07, 95%CI 1.01,1.13, P = 0.029). No difference was found concerning the rate of hospitalization and invasive mechanical ventilation between the two groups.

CONCLUSION

Individuals diagnosed with eosinophilic AECOPD had a reduced mortality rate, a truncated period of hospitalization, and an insubstantial increase in the probability of readmission relative to their non-eosinophilic AECOPD counterparts. The level of eosinophils in blood has been shown to serve as a potential predictive biomarker for AECOPD patients.

Impact of Acute Exacerbation and Its Phenotypes on the Clinical Outcomes of Chronic Obstructive Pulmonary Disease in Hospitalized Patients: A Cross-Sectional Study

Acute exacerbations of COPD (AECOPD) are clinically significant events having therapeutic and prognostic consequences. However, there is a lot of variation in its clinical manifestations described by phenotypes. The phenotypes of AECOPD were categorized in this study based on pathology and exposure. In our cross-sectional study, conducted between 1 January 2016 to 31 December 2020, the patients were categorized into six groups based on pathology: non-bacterial and non-eosinophilic; bacterial; eosinophilic; bacterial infection with eosinophilia; pneumonia; and bronchiectasis. Further, four groups were classified based on exposure to tobacco smoke (TS), biomass smoke (BMS), both, or no exposure. Cox proportional-hazards regression analyses were performed to assess hazard ratios, and Kaplan-Meier analysis was performed to assess survival, which was then compared using the log-rank test. The odds ratio (OR) and independent predictors of ward admission type and length of hospital stay were assessed using binomial logistic regression analyses. Of the 2236 subjects, 2194 were selected. The median age of the cohort was 67.0 (60.0 to 74.0) and 75.2% were males. Mortality rates were higher in females than in males (6.2% vs. 2.3%). AECOPD-B (bacterial infection) subjects [HR 95% CI 6.42 (3.06-13.46)], followed by AECOPD-P (pneumonia) subjects [HR (95% CI: 4.33 (2.01-9.30)], were at higher mortality risk and had a more extended hospital stay (6.0 (4.0 to 9.5) days; 6.0 (4.0 to 10.0). Subjects with TS and BMS-AECOPD [HR 95% CI 7.24 (1.53-34.29)], followed by BMS-AECOPD [HR 95% CI 5.28 (2.46-11.35)], had higher mortality risk. Different phenotypes have different impacts on AECOPD clinical outcomes. A better understanding of AECOPD phenotypes could contribute to developing an algorithm for the precise management of different phenotypes.