Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong Special Administrative Region, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2023 Jun 12;18:1145-1153. doi: 10.2147/COPD.S401357. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) phenotyping using stable-state blood eosinophil level was shown to have prognostic implication in terms of exacerbation risk. However, using a single cut-off of blood eosinophil level to predict clinical outcome has been challenged. There have been suggestions that variability of blood eosinophil count at stable-state could provide additional information on exacerbation risk.
A retrospective cohort study was conducted in a major regional hospital and a tertiary respiratory referral centre in Hong Kong, including 275 Chinese patients with COPD, to investigate the possible role of variability of blood eosinophil count at stable-state to predict COPD exacerbation risk in one year.
Higher variability of baseline eosinophil count, which is defined as the difference of the minimal and maximal eosinophil count at stable-state, was associated with increased risk of COPD exacerbation in the follow-up period with adjusted OR (aOR) of 1.001 (95% CI = 1.000-1.003, p-value = 0.050) for 1 unit (cells/µL) increase in variability of baseline eosinophil count, aOR of 1.72 (95% CI = 1.00-3.58, p-value = 0.050) for 1 SD increase in variability of baseline eosinophil count and aOR of 1.06 (95% CI = 1.00-1.13) for 50 cells/µL increase in variability of baseline eosinophil count. The AUC by ROC analysis was 0.862 (95% CI = 0.817-0.907, p-value < 0.001). The cut-off for variability of baseline eosinophil count identified was 50 cells/µL, with sensitivity of 82.9% and specificity of 79.3%. Similar findings were also shown in the subgroup with stable-state baseline eosinophil count below 300 cells/µL.
Variability of baseline eosinophil count at stable-state might predict the exacerbation risk of COPD, exclusively among patients with baseline eosinophil count below 300 cells/µL. The cut-off value for variability was 50 cells/µValidation of the study findings in large scale prospective study would be meaningful.
采用稳定状态时血嗜酸性粒细胞水平对慢性阻塞性肺疾病（COPD）进行表型分析，其在预测加重风险方面具有预后意义。然而，使用单一的血嗜酸性粒细胞水平临界值来预测临床结局一直受到挑战。有人认为，稳定状态时血嗜酸性粒细胞计数的变异性可以提供更多有关加重风险的信息。
本研究是在香港一家主要的区域医院和三级呼吸转诊中心进行的回顾性队列研究，共纳入 275 例 COPD 中国患者，旨在探讨稳定状态时血嗜酸性粒细胞计数的变异性是否可以预测 COPD 患者在 1 年内的加重风险。
基线嗜酸性粒细胞计数的变异性较高（定义为稳定状态时的最低值与最高值之差）与随访期间 COPD 加重的风险增加相关，经调整后的比值比（OR）为 1.001（95%CI=1.000-1.003，p 值=0.050），即基线嗜酸性粒细胞计数的变异性每增加 1 个单位（细胞/µL）；OR 为 1.72（95%CI=1.00-3.58，p 值=0.050），即基线嗜酸性粒细胞计数的变异性增加 1 个标准差；OR 为 1.06（95%CI=1.00-1.13），即基线嗜酸性粒细胞计数的变异性增加 50 个细胞/µL。ROC 分析的 AUC 为 0.862（95%CI=0.817-0.907，p 值<0.001）。确定的基线嗜酸性粒细胞计数变异性的临界值为 50 个细胞/µL，其敏感性为 82.9%，特异性为 79.3%。在稳定状态时嗜酸性粒细胞计数低于 300 个细胞/µL 的亚组中也观察到了类似的结果。
稳定状态时嗜酸性粒细胞计数的变异性可能可以预测 COPD 的加重风险，仅适用于稳定状态时嗜酸性粒细胞计数低于 300 个细胞/µL 的患者。变异性的临界值为 50 个细胞/µL。在大规模前瞻性研究中验证研究结果将具有重要意义。
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