Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, Cancer Hospital Affiliate to School of Medicine, UESTC, Chengdu, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2023 Feb 28;18:169-179. doi: 10.2147/COPD.S396311. eCollection 2023.
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.
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.
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).
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.
血液嗜酸性粒细胞在慢性阻塞性肺疾病急性加重（AECOPD）患者中的预后价值仍存在争议。本研究旨在评估血液嗜酸性粒细胞是否可以预测 AECOPD 住院患者的住院期间死亡率和其他不良结局。
前瞻性纳入来自中国十个医学中心的 AECOPD 住院患者。入院时检测外周血嗜酸性粒细胞，并以 2%为截断值将患者分为嗜酸性粒细胞组和非嗜酸性粒细胞组。主要结局为全因住院期间死亡率。
共纳入 12831 例 AECOPD 住院患者。总体队列中，非嗜酸性粒细胞组的住院期间死亡率高于嗜酸性粒细胞组（1.8% vs 0.7%，P < 0.001），肺炎亚组（2.3% vs 0.9%，P = 0.016）或呼吸衰竭亚组（2.2% vs 1.1%，P = 0.009），但 ICU 入院亚组（8.4% vs 4.5%，P = 0.080）并非如此。即使在校正了 ICU 入院亚组的混杂因素后，这种关联仍然存在。在总体队列和所有亚组中保持一致，非嗜酸性粒细胞性 AECOPD 还与更高的有创机械通气率（4.3% vs 1.3%，P < 0.001）、ICU 入院率（8.9% vs 4.2%，P < 0.001）以及出乎意料的全身皮质激素使用率（45.3% vs 31.7%，P < 0.001）相关。非嗜酸性粒细胞性 AECOPD 与总体队列和呼吸衰竭亚组的住院时间延长相关（均 P < 0.001），但与肺炎亚组（P = 0.341）或 ICU 入院亚组（P = 0.934）无关。
入院时外周血嗜酸性粒细胞可作为预测大多数 AECOPD 住院患者住院期间死亡率的有效生物标志物，但不能预测 ICU 入院患者的死亡率。嗜酸性粒细胞指导的皮质激素治疗应进一步研究，以更好地指导皮质激素在临床实践中的应用。
