Huang Wei-Chang, Lee Ching-Hsiao, Wu Ming-Feng, Huang Chen-Cheng, Hsu Cheng-Hui, Chen Hui-Chen, Hsu Jeng-Yuan, Huang Chieh-Chen
Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
BMJ Open. 2018 Sep 11;8(9):e020341. doi: 10.1136/bmjopen-2017-020341.
The clinical implications of blood eosinophil level in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission are still unknown. Thus, this study aimed to compare the features of such patients with and without blood eosinophilia.
This was a retrospective case-control study.
An ICU of a medical centre in central Taiwan.
A total of 262 patients with COPD and CAP requiring IMV and ICU admission.
Of all participants (n=262), 32 (12.2%) had an eosinophil percentage (EP) >2% and 169 (64.5%) had an absolute eosinophil count (AEC) >300 cells/µL. Regardless of whether 2% or 300 cells/µL was used as a cut-off value, the eosinophilia group were slightly older (years) (82.9±5.4 vs 78.1±9.1, p=0.000 and 79.2±8.4 vs 77.6±9.6, p=0.246, respectively), and had a higher forced expiratory volume in 1 s/forced vital capacity (%) (56.0±8.0 vs 51.3±11.6, p=0.005 and 53.1±11.2 vs 49.5±11.2, p=0.013, respectively), less severe spirometric classification (p=0.008 and p=0.001, respectively), and lower white cell count 10/L (8.8±3.2 vs 11.1±4.9, p=0.009 and 10.3±4.4 vs 11.8±5.3, p=0.017, respectively) than the non-eosinophilia group. The bacteriology of endotracheal aspirates showed that and other gram-negative bacilli were the most common organisms in all study groups. Participants with an EP >2% had a shorter ICU length of stay (OR=12.13, p=0.001) than those with an EP ≤2%, while an AEC >300 cells/µL was not associated with any in-ICUoutcomes.
The results of this study have significant clinical implications and should be considered when making treatment decisions for the management of patients with COPD and CAP requiring IMV and ICU admission.
慢性阻塞性肺疾病（COPD）合并社区获得性肺炎（CAP）且需要有创机械通气（IMV）及入住重症监护病房（ICU）的患者，其血液嗜酸性粒细胞水平的临床意义尚不清楚。因此，本研究旨在比较此类有或无血液嗜酸性粒细胞增多症患者的特征。
这是一项回顾性病例对照研究。
台湾中部某医疗中心的ICU。
共有262例COPD合并CAP且需要IMV及入住ICU的患者。
在所有参与者（n = 262）中，32例（12.2%）嗜酸性粒细胞百分比（EP）>2%，169例（64.5%）绝对嗜酸性粒细胞计数（AEC）>300个/μL。无论将2%还是300个/μL作为临界值，嗜酸性粒细胞增多症组均比非嗜酸性粒细胞增多症组年龄稍大（岁）（分别为82.9±5.4对78.1±9.1，p = 0.000；79.2±8.4对77.6±9.6，p = 0.246），第1秒用力呼气容积/用力肺活量（%）更高（分别为56.0±8.0对51.3±11.6，p = 0.005；53.1±11.2对49.5±11.2，p = 0.013），肺量计分级较轻（分别为p = 0.008和p = 0.001），白细胞计数更低（10⁹/L）（分别为8.8±3.2对11.1±4.9，p = 0.009；10.3±4.4对11.8±5.3，p = 0.017）。气管内吸出物的细菌学检查显示，在所有研究组中，铜绿假单胞菌和其他革兰阴性杆菌是最常见的病原体。EP>2%的参与者ICU住院时间较短（OR = 12.13，p = 0.001），而AEC>300个/μL与任何ICU结局均无关联。
本研究结果具有重要的临床意义，在对需要IMV及入住ICU的COPD合并CAP患者进行治疗决策时应予以考虑。
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