嗜酸性粒细胞减少作为慢性阻塞性肺疾病急性加重期无创通气使用的预后生物标志物
Eosinopenia as a Prognostic Biomarker for Noninvasive Ventilation Use in COPD Exacerbations.
作者信息
Bartziokas Konstantinos, Papathanasiou Evgenia, Papaioannou Andriana I, Papanikolaou Ilias, Antonakis Emmanouil, Makou Ioanna, Hillas Georgios, Karampitsakos Theodoros, Papaioannou Ourania, Dimakou Katerina, Apollonatou Vasiliki, Verykokou Galateia, Papiris Spyros, Bakakos Petros, Loukides Stelios, Kostikas Konstantinos
机构信息
Respiratory Medicine Department, University of Ioannina, 45110 Ioannina, Greece.
2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 10679 Athens, Greece.
出版信息
J Pers Med. 2023 Apr 19;13(4):686. doi: 10.3390/jpm13040686.
BACKGROUND
In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects. During an exacerbation of COPD, eosinopenia has been proposed as a prognostic marker of adverse outcomes.
OBJECTIVES
The aim of the present post hoc analysis was to elucidate the effectiveness of blood eosinophils for predicting the need of NIV in subjects with COPD exacerbation.
METHODS
Consecutive subjects admitted to a hospital for COPD exacerbation were included in the analysis. The eosinophil count from the first complete blood count was used to designate the eosinophil groups. The relationship between the clinical characteristics and blood eosinophil counts, as dichotomized using 150 cells/μL, was evaluated. Results Subjects with blood eosinophil number < 150 k/μL had a more severe disease on admission compared to subjects with ≥150 k/μL, regarding pH 7.400 (7.36, 7.44) vs. 7.42 (7.38, 7.45), = 0.008, PO/FiO levels 238.1 (189.8, 278.6) vs. 276.2 (238.2, 305.6), < 0.001, CRP (mg/L) levels 7.3 (3.1, 19.9) vs. 3.5 (0.7, 7.8), < 0.001 and required a longer hospital stay (days) 10.0 (8.0, 14.0) vs. 5.0 (3.0, 7.0) < 0.001 respectively. The number of blood eosinophils correlated with the levels of CRP upon admission ( < 0.001, r = -0.334), with arterial pH upon admission ( < 0.030, r = 0.121), with PO/FiO ( < 0.001, r = -0.248), and with duration of hospital stay ( < 0.001, r = -0.589). In the multinomial logistic regression analysis, blood eosinophil count < 150 k/μL was an independent predictor of the use of NIV during hospital stay.
CONCLUSION
During COPD exacerbation, low blood eosinophil levels upon admission are related to more severe disease and can be used as a predictor of the need of NIV. Further prospective studies are needed to identify the use of blood eosinophil levels as a predictor of unfavorable outcomes.
背景
近年来，血液嗜酸性粒细胞已被评估为嗜酸性气道炎症的替代生物标志物以及住院慢性阻塞性肺疾病（COPD）患者预后的指标。在COPD急性加重期，嗜酸性粒细胞减少被认为是不良预后的预测指标。
目的
本事后分析的目的是阐明血液嗜酸性粒细胞对预测COPD急性加重患者无创通气（NIV）需求的有效性。
方法
纳入因COPD急性加重连续入院的患者进行分析。首次全血细胞计数中的嗜酸性粒细胞计数用于划分嗜酸性粒细胞组。评估临床特征与以150个细胞/μL进行二分的血液嗜酸性粒细胞计数之间的关系。结果血液嗜酸性粒细胞数<150 k/μL的患者入院时病情比≥150 k/μL的患者更严重，pH值分别为7.400（7.36，7.44）vs. 7.42（7.38，7.45），P = 0.008；动脉血氧分压/吸入氧分数（PO/FiO）水平分别为238.1（189.8，278.6）vs. 276.2（238.2，305.6），P<0.001；C反应蛋白（CRP）（mg/L）水平分别为7.3（3.1, 19.9）vs. 3.5（0.7, 7.8），P<0.001，且住院时间更长（天数）分别为10.0（8.0, 14.0）vs. 5.0（3.0, 7.0），P<0.001。血液嗜酸性粒细胞数量与入院时CRP水平相关（P<0.001，r = -0.334），与入院时动脉pH值相关（P<0.030，r = 0.121），与PO/FiO相关（P<0.001，r = -0.248），与住院时间相关（P<0.001，r = -0.589）。在多项逻辑回归分析中，血液嗜酸性粒细胞计数<150 k/μL是住院期间使用NIV的独立预测因素。
结论
在COPD急性加重期，入院时血液嗜酸性粒细胞水平低与病情更严重相关，可作为NIV需求的预测指标。需要进一步的前瞻性研究来确定血液嗜酸性粒细胞水平作为不良预后预测指标的用途。
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