Li Jiachen, Liang Lirong, Feng Lin, Cao Siyu, Cai Yutong Samuel, Li Xiaobo, Qian Zhenbei, Brightling Christopher E, Tong Zhaohui
Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
J Inflamm Res. 2023 Aug 2;16:3233-3243. doi: 10.2147/JIR.S421605. eCollection 2023.
Blood eosinophil is a promising biomarker for phenotyping patients with acute exacerbation of COPD (AECOPD). We aimed to evaluate the prognostic value of eosinophil on short- and long-term outcomes stratified by corticosteroid treatment among AECOPD inpatients.
In this retrospective cohort study, we included patients hospitalized for AECOPD from July 2013 to June 2021 in Beijing, China. Clinical data were collected from electronic medical records. The blood eosinophil count was measured within 24h after admission. Eosinophilic AECOPD was defined as having an eosinophil percentage ≥ 2%. The study outcomes were length of stay (LOS), treatment failure, and AECOPD readmission risk within 3 years of discharge. Multivariable models were used to analyze the associations between blood eosinophil count and outcomes stratified by corticosteroid treatment during hospitalization.
A total of 2406 AECOPD patients were included. The median LOS of AECOPD patients was 10 (interquartile range: 8-14) days. The eosinophil percentage was negatively associated with LOS (P-trend=0.014). Compared with the non-eosinophilic AECOPD group, the eosinophilic group had a 58% lower risk of treatment failure (OR=0.42, 95% CI: 0.20-0.89) in patients treated with systemic corticosteroids, but no association was observed in those treated with inhaled corticosteroids (ICS) only (OR=0.95, 95% CI: 0.60-1.52). The eosinophilic group had an increased risk of 90-day re-admission in patients treated with ICS only (HR=1.51, 95% CI: 1.00-2.29), but not in patients treated with systemic corticosteroids during hospitalization (HR=0.67, 95% CI: 0.39-1.15). No statistically significant results were found for 180-day, 1-year, or 3-year readmission risk.
Elevated blood eosinophils in AECOPD were associated with shorter length of stay and improved response to treatment with systemic corticosteroids, but not inhaled corticosteroids. Our study suggested that a therapeutic approach of using systemic corticosteroid may benefit patients present with eosinophilic AECOPD.
血液嗜酸性粒细胞是慢性阻塞性肺疾病急性加重期（AECOPD）患者表型分析中有前景的生物标志物。我们旨在评估嗜酸性粒细胞对AECOPD住院患者短期和长期预后的预测价值，这些预后按皮质类固醇治疗进行分层。
在这项回顾性队列研究中，我们纳入了2013年7月至2021年6月在中国北京因AECOPD住院的患者。临床数据从电子病历中收集。入院后24小时内测量血液嗜酸性粒细胞计数。嗜酸性粒细胞性AECOPD定义为嗜酸性粒细胞百分比≥2%。研究结局为住院时间（LOS）、治疗失败以及出院后3年内AECOPD再入院风险。多变量模型用于分析血液嗜酸性粒细胞计数与住院期间按皮质类固醇治疗分层的结局之间的关联。
共纳入2406例AECOPD患者。AECOPD患者的中位住院时间为10（四分位间距：8 - 14）天。嗜酸性粒细胞百分比与住院时间呈负相关（P趋势 = 0.014）。与非嗜酸性粒细胞性AECOPD组相比，在接受全身皮质类固醇治疗的患者中，嗜酸性粒细胞性组治疗失败风险降低58%（OR = 0.42，95%CI：0.20 - 0.89），但在仅接受吸入性皮质类固醇（ICS）治疗的患者中未观察到关联（OR = 0.95，95%CI：0.60 - 1.52）。在仅接受ICS治疗的患者中，嗜酸性粒细胞性组90天再入院风险增加（HR = 1.51，95%CI：1.00 - 2.29），但在住院期间接受全身皮质类固醇治疗的患者中未增加（HR = 0.67，95%CI：0.39 - 1.15）。对于180天、1年或3年再入院风险，未发现具有统计学意义的结果。
AECOPD患者血液嗜酸性粒细胞升高与住院时间缩短以及对全身皮质类固醇治疗而非吸入性皮质类固醇治疗的反应改善相关。我们的研究表明，使用全身皮质类固醇的治疗方法可能使嗜酸性粒细胞性AECOPD患者受益。
