Department Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands.
Department Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands.
Respir Med. 2017 Oct;131:118-124. doi: 10.1016/j.rmed.2017.07.064. Epub 2017 Aug 1.
Blood eosinophilia is frequently encountered in patients with AECOPD. However the impact of blood eosinophilia at admission in patients with AECOPD on outcome on the short and long term has not been extensively studied which was the objective of the present study.
We used data of 207 exacerbations from a randomized clinical trial on antibiotic prescription based upon CRP-levels versus GOLD guided strategy and analyzed the impact of blood eosinophils (≥2% of total white cell count and eosinophil count ≥300 cell/microliter) on clinical outcome.
207 patients were included of whom 39 (18·8%) had eosinophilia ≥2%, 23 patients (11.1%) had blood eosinophil ≥300 cell/microliter. Eosinophilia was associated with shorter median length of stay in the eosinophilic groups(≥2% and ≥300 cell/microliter) compared to the non-eosinophilic groups. Early treatment failure was reduced in the both the eosinophilic groups (≥2% and ≥300 cell/microliter). Late treatment failure (day 11-30) did not differ between the groups. Relapse, was more frequent the eosinophilic groups (≥2% and ≥300 cell/microliter), however in the latter group this did not reach statistical significance. Eosinophilia ≥2% was a risk factor for having relapse (eosinophilia ≥2%: HR = 2·351; 95%CI 1·335-4·139), whereas eosinophilia <2% was associated with a lower risk factor for having early treatment failure (HR = 0·339 95%CI 0·122-0·943).
We showed that blood eosinophilia at admission in patients with an AECOPD is associated with higher short-term treatment success rate. However, blood eosinophilia ≥2% predicts a less favorable outcome due to an increased risk of relapse.
NCT01232140.
AECOPD 患者常出现血嗜酸性粒细胞增多。然而，AECOPD 患者入院时血嗜酸性粒细胞增多对近期和远期预后的影响尚未得到广泛研究，本研究旨在探讨这一问题。
我们使用了一项基于 CRP 水平与 GOLD 指导策略的抗生素处方随机临床试验中的 207 例加重期数据，并分析了血嗜酸性粒细胞（白细胞总数的≥2%和嗜酸性粒细胞计数≥300 个/µL）对临床结局的影响。
共纳入 207 例患者，其中 39 例（18.8%）存在嗜酸性粒细胞增多≥2%，23 例（11.1%）存在血嗜酸性粒细胞计数≥300 个/µL。与非嗜酸性粒细胞增多组相比，嗜酸性粒细胞增多组（≥2%和≥300 个/µL）的中位住院时间更短。两组早期治疗失败率均降低。晚期治疗失败（第 11-30 天）在两组间无差异。嗜酸性粒细胞增多组（≥2%和≥300 个/µL）的复发更常见，但在后一组中差异无统计学意义。嗜酸性粒细胞增多≥2%是发生复发的危险因素（嗜酸性粒细胞增多≥2%：HR=2.351；95%CI 1.335-4.139），而嗜酸性粒细胞计数<2%与早期治疗失败的风险降低相关（HR=0.339；95%CI 0.122-0.943）。
我们发现，AECOPD 患者入院时的血嗜酸性粒细胞增多与较高的短期治疗成功率相关。然而，血嗜酸性粒细胞增多≥2%预示着预后较差，因为复发风险增加。
NCT01232140。
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