Respiratory Research Unit, Department of Respiratory and Infectious Disease, Bispebjerg University Hospital, Copenhagen, Denmark.
Department of Respiratory Medicine, Antwerp University Hospital, Edegem, Belgium.
J Asthma. 2024 Dec;61(12):1715-1726. doi: 10.1080/02770903.2024.2380510. Epub 2024 Aug 22.
Acute exacerbations (AEs) of asthma are heterogeneous in terms of triggers, outcomes, and treatment response. This study investigated biomarker defined infective and inflammatory AE phenotypes in hospitalized adult asthma patients, and their impact on clinical outcomes and phenotype stability at AE recurrence.
Patients with asthma admitted with an AE between January 2010 and December 2011 with a 3-year follow-up were retrospectively studied. AEs were categorized into infective (CRP >10 mg/L) vs non-infective, eosinophilic (blood eosinophils ≥ 0.2 × 10 cells/L) vs non-eosinophilic, and viral (CRP >10 to <40 mg/L) vs bacterial (CRP ≥40 mg/L) phenotypes. Clinical impact of the index AE, the risk and time to a second AE and AE phenotype stability were analyzed using Kaplan-Meier survival curves and McNamar's test.
294 asthma patients were included: 47% had infective AE with a longer length of stay than non-infective AE (2.0 vs. 1.0 days, = 0.01). The proportion of patients with eosinophilic AEs was evenly distributed across infective and non-infective AE (40% vs. 46%), although more patients with viral had eosinophilia than bacterial AE (46% vs. 26%). During follow-up, 18% had recurrent AE; with a higher risk in viral AE than bacterial AE (25% vs. 8%, = 0.02). Both inflammatory and infective AE phenotype were stable at recurrent AE.
AE phenotyping in hospitalized asthma patients, based on CRP and blood eosinophils, revealed prolonged hospital stay in infective AEs and a higher risk of recurrent AE requiring hospitalization in viral versus bacterial AEs. Moreover, infective, and inflammatory AE phenotypes were rather stable at recurrent AE. Our results suggest a role for biomarker guided phenotyping of AEs of asthma.
哮喘急性加重（AE）在诱因、结局和治疗反应方面存在异质性。本研究旨在探讨住院成人哮喘患者中基于生物标志物的感染性和炎症性 AE 表型及其在 AE 复发时对临床结局和表型稳定性的影响。
回顾性分析了 2010 年 1 月至 2011 年 12 月期间因 AE 住院并进行了 3 年随访的哮喘患者。将 AE 分为感染性（CRP>10mg/L）与非感染性、嗜酸性粒细胞性（血嗜酸性粒细胞≥0.2×109/L）与非嗜酸性粒细胞性、病毒性（CRP>10-<40mg/L）与细菌性（CRP≥40mg/L）表型。采用 Kaplan-Meier 生存曲线和 McNamar's 检验分析指数 AE 的临床影响、再次 AE 的风险和时间以及 AE 表型的稳定性。
共纳入 294 例哮喘患者，其中 47%为感染性 AE，住院时间长于非感染性 AE（2.0 天比 1.0 天， = 0.01）。感染性和非感染性 AE 患者中嗜酸性粒细胞性 AE 的比例分布均匀（40%比 46%），但病毒性 AE 中嗜酸性粒细胞增多的患者比例高于细菌性 AE（46%比 26%）。随访期间，18%的患者发生了复发性 AE，病毒性 AE 的风险高于细菌性 AE（25%比 8%， = 0.02）。在复发性 AE 中，炎症性和感染性 AE 表型均稳定。
基于 CRP 和血嗜酸性粒细胞对住院哮喘患者 AE 进行表型分析，结果显示感染性 AE 患者的住院时间延长，病毒性 AE 比细菌性 AE 更易发生需要住院治疗的复发性 AE。此外，感染性和炎症性 AE 表型在复发性 AE 中较为稳定。我们的研究结果提示，基于生物标志物的哮喘 AE 表型分析可能具有一定的作用。
