Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Tuberculosis, The Third People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
PLoS One. 2024 Oct 3;19(10):e0302318. doi: 10.1371/journal.pone.0302318. eCollection 2024.
The association between blood eosinophils and COPD exacerbation has been controversial. This study aims to investigate whether high blood eosinophils predict the risk of COPD exacerbation across different thresholds and subgroups.
PubMed, Embase and Web of science were searched for randomized controlled trial (RCT) and observational studies regarding the relationship between blood eosinophils and COPD exacerbation. Pooled risk ratio (RR) for COPD exacerbation was calculated using the Mantel-Haenszel method with a random-effects model.
A total of 21 studies (1 RCT and 20 observational studies) with 79868 participants were included. Thresholds of high blood eosinophils including absolute counts (200, 300 and 400 cell/μL) and percentages (2%, 3% and 4%) were analyzed respectively. Pooled analyses suggested that high blood eosinophils were significantly associated with increased risk of COPD exacerbation when using the thresholds of 300 cells/μL (RR 1.21, 95%CI 1.12-1.30, P <0.001, 16 studies), 400 cells/μL (RR 1.79, 95%CI 1.41-2.28, P <0.001, 3 studies), 2% (RR 1.26, 95%CI 1.02-1.55, P = 0.030, 10 studies) and 4% (RR 1.44, 95%CI 1.05-1.96, P = 0.022, 4 studies), but not 200 cells/μL and 3% (P>0.05). Moreover, high blood eosinophils contributed to moderate-severe exacerbation of COPD by the cutoffs of 300 cells/μL (RR 1.30, 95%CI 1.16-1.45, P<0.001, 11 studies) and 2% (RR 1.33, 95%CI 1.02-1.76, P = 0.037, 8 studies). In subgroup analyses, the pooled results further showed a significant association between high blood eosinophils (especially over 300 cells/μL) and risk of COPD exacerbation among patients from Europe and Asia, and whether with stable or exacerbation phase at baseline, and regardless of the follow-up time (≤ or > 1year).
This study demonstrates that high blood eosinophils (over 300 cells/μL or 2%) could predict the risk of moderate-severe exacerbation of COPD in specific subgroups. However, large sample-sized, prospective, and well-designed studies are required to validate the present findings.
血液嗜酸性粒细胞与 COPD 加重之间的关联一直存在争议。本研究旨在探讨高嗜酸性粒细胞是否能预测不同阈值和亚组 COPD 加重的风险。
通过 PubMed、Embase 和 Web of Science 检索了关于血液嗜酸性粒细胞与 COPD 加重关系的随机对照试验（RCT）和观察性研究。使用 Mantel-Haenszel 方法和随机效应模型计算 COPD 加重的汇总风险比（RR）。
共纳入 21 项研究（1 项 RCT 和 20 项观察性研究），涉及 79868 名参与者。分别分析了高嗜酸性粒细胞的不同阈值（绝对计数 200、300 和 400 细胞/μL，以及百分比 2%、3%和 4%）。汇总分析表明，当使用 300 细胞/μL（RR 1.21，95%CI 1.12-1.30，P<0.001，16 项研究）、400 细胞/μL（RR 1.79，95%CI 1.41-2.28，P<0.001，3 项研究）、2%（RR 1.26，95%CI 1.02-1.55，P=0.030，10 项研究）和 4%（RR 1.44，95%CI 1.05-1.96，P=0.022，4 项研究）时，高嗜酸性粒细胞与 COPD 加重风险显著相关，但当使用 200 细胞/μL 和 3%时（P>0.05）不相关。此外，高嗜酸性粒细胞与 300 细胞/μL（RR 1.30，95%CI 1.16-1.45，P<0.001，11 项研究）和 2%（RR 1.33，95%CI 1.02-1.76，P=0.037，8 项研究）的截断值与 COPD 中重度加重有关。在亚组分析中，汇总结果进一步表明，高嗜酸性粒细胞（尤其是超过 300 细胞/μL）与欧洲和亚洲患者 COPD 加重风险之间存在显著相关性，且无论基线时处于稳定期还是加重期，以及无论随访时间（≤或>1 年）如何，均存在显著相关性。
本研究表明，高嗜酸性粒细胞（超过 300 细胞/μL 或 2%）可预测特定亚组中 COPD 中重度加重的风险。然而，需要更大样本量、前瞻性和精心设计的研究来验证本研究结果。
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