Low and High Blood Eosinophil Counts as Biomarkers in Hospitalized Acute Exacerbations of COPD (original) (raw)
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Introduction; An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that results in additional therapy. COPD has eosinophilic airway inflammation both in a stable state and during exacerbations Although the eosinophil threshold associated with clinical relevance in patients with COPD is currently subject to debate, eosinophil counts hold potential as biomarkers to guide therapy. Aims and objectives; To estimate absolute blood eosinophil count and its correlation with in hospital length of stay in COPD-AE. Materials and methods; Pre-treatment laboratory complete blood count with differential, absolute eosinophil count were sent. Pre-treatment absolute blood eosinophil counts analyzed for its association with in hospital length of stay in COPD acute exacerbation. Results & Discussion; Among 50 cases 80% cases are males and 20% cases are females. Maximum number of cases (18) fell between 61-70 years of age., patients with absolute eosinophil count less than 300 cells/μl stayed in the hospital for a longer period of time as compared to patients exhibiting a higher eosinophil count at the time of admission. Conclusion; The patients with low absolute blood eosinophil counts have longer length of stay compared to high blood absolute eosinophil counts.
Turkish Thoracic Journal
OBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE ≤2%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRP, NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20×103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20×103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.
International Journal of Chronic Obstructive Pulmonary Disease, 2015
Background: COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%-25% of COPD exacerbations are eosinophilic. Aim: To assess whether eosinophilic COPD exacerbations have better outcomes than noneosinophilic COPD exacerbations in the ICU. Methods: This retrospective observational cohort study was conducted in a thoracic, surgerylevel III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects' characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (.2% or #2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data. Results: Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2-7 days) vs 6 days (3-9 days) (P,0.002), and 12.9% vs 24.9% (P,0.034), respectively. Conclusion: COPD exacerbations with acute respiratory failure requiring ICU admission had a better outcome with a peripheral eosinophil level .2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management.
American Journal of Respiratory and Critical Care Medicine, 2012
Rationale: Exacerbations of chronic obstructive pulmonary disease (COPD) and responses to treatment are heterogeneous. Objectives: Investigate the usefulness of blood eosinophils to direct corticosteroid therapy during exacerbations. Methods: Subjects with COPD exacerbations were entered into a randomized biomarker-directed double-blind corticosteroid versus standard therapy study. Subjects in the standard arm received prednisolone for 2 weeks, whereas in the biomarker-directed arm, prednisolone or matching placebo was given according to the blood eosinophil count biomarker. Both study groups received antibiotics. Blood eosinophils were measured in the biomarker-directed and standard therapy arms to define biomarker-positive and-negative exacerbations (blood eosinophil count. and < 2%, respectively). The primary outcome was to determine noninferiority in health status using the chronic respiratory questionnaire (CRQ) and in the proportion of exacerbations associated with a treatment failure between subjects allocated to the biomarker-directed and standard therapy arms. Measurements and Main Results: There were 86 and 80 exacerbations in the biomarker-directed and standard treatment groups, respectively. In the biomarker-directed group, 49% of the exacerbations were not treated with prednisolone. CRQ improvement after treatment in the standard and biomarker-directed therapy groups was similar (0.8 vs. 1.1; mean difference, 0.3; 95% confidence interval, 0.0-0.6; P ¼ 0.05). There was a greater improvement in CRQ in biomarker-negative exacerbations given placebo compared with those given prednisolone (mean difference, 0.45; 95% confidence interval, 0.01-0.90; P ¼ 0.04). In biomarker-negative exacerbations, treatment failures occurred in 15% given prednisolone and 2% of those given placebo (P ¼ 0.04). Conclusions: The peripheral blood eosinophil count is a promising biomarker to direct corticosteroid therapy during COPD exacerbations, but larger studies are required. Clinical trial registered with www.controlled-trials.com (ISRCTN 92422949).
Romanian Journal of Internal Medicine
Introduction: Eosinopenia has been previously investigated as a marker to differentiate infectious from non-infectious diagnoses and as a prognostic marker. Most previous studies were conducted in intensive care unit patients. Our study focuses on the value of eosinopenia in patients admitted to the Internal Medicine department. Methods: We retrospectively analyzed 271 consecutive patients with infection and 31 patients presenting with fever or inflammatory syndrome and a non-infectious diagnosis. We evaluated and compared the following markers for differentiating infectious from non-infectious diagnoses: eosinophil count [EC], CRP, WBC and neutrophil-to-lymphocyte count ratio [NLCR]. We also evaluated the value of eosinopenia as a monitoring parameter in patients with infections. Results: Eosinopenia at admission was found in 71% of patients with infection compared to 32% in the non-infection group. EC and NLCR were moderate markers for discriminating infection from non-infection, ...
Blood eosinophil count and exacerbation risk in patients with COPD
The European respiratory journal, 2017
Exacerbations in chronic obstructive pulmonary disease (COPD) are major contributors to worsening lung function, impaired quality of life, emergency healthcare use and COPD-related mortality. COPD exacerbations are heterogeneous in terms of airway inflammation and aetiology. About 60% of COPD patients have blood eosinophil counts of ⩾2%, which appears to be associated with an increased risk of exacerbations [1-3]. However, the association between blood eosinophil counts at stable disease and COPD exacerbations in the subsequent year is incompletely understood.
International Journal of Chronic Obstructive Pulmonary Disease, 2015
Background: COPD exacerbations requiring hospitalization increase morbidity and mortality. Although most COPD exacerbations are neutrophilic, approximately 10%-25% of exacerbations are eosinophilic. Aim: We aimed to evaluate mortality and outcomes of eosinophilic and non-eosinophilic COPD exacerbations and identify new biomarkers that predict survival. Methods: A retrospective observational cohort study was carried out in a tertiary teaching hospital from January 1, 2014 to November 1, 2014. All COPD patients hospitalized with exacerbations were enrolled in the study at their initial hospitalization and followed-up for 6 months after discharge. Electronic data were collected from the hospital database. Subjects' characteristics, hemogram parameters, CRP levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-mean platelet volume ratio on admission and discharge, length of hospital stay (days), readmissions, and mortality were recorded. Patients were grouped according to peripheral blood eosinophil (PBE) levels: Group 1, .2% PBE, eosinophilic; Group 2, non-eosinophilic #2%. Patient survival after hospital discharge was evaluated by Kaplan-Meier survival analysis. Results: A total of 1,704 patients hospitalized with COPD exacerbation were included. Approximately 20% were classified as eosinophilic. Six-month mortality was similar in eosinophilic and non-eosinophilic groups (14.2% and 15.2%, respectively); however, the hospital stay length and readmission rate were longer and higher in the non-eosinophilic group (P,0.001 and P,0.01, respectively). CRP and NLR were significantly higher in the non-eosinophilic group (both P,0.01). The platelet-to-mean platelet volume ratio was not different between the two groups. Cox regression analysis showed that survival was negatively influenced by elevated CRP (P,0.035) and NLR (P,0.001) in the non-eosinophilic group. Conclusion: Non-eosinophilic patients with COPD exacerbations with high CRP and NLR values had worse outcomes than eosinophilic patients. PBE and NLR can be helpful markers to guide treatment decisions.
Pakistan Journal of Medical and Health Sciences
Objective: To determine the frequency of eosinophilia in patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD). Patients and Methods: A total number 217 patients presenting with AECOPD were included from August-2021 to March-2022. Data regarding patients age, gender, diabetes, hypertension, smoking and duration of COPD was collected for each patient. After inclusion, venous blood samples were taken and were analyzed for presence of eosinophilia. Results: Mean age of patients was 59.32±8.92 years. Mean duration of COPD was 6.56±2.49 years. There were 127 (74.7%) male and 43 (25.3%) female patients. Out of 170, 121 (71.2%) patients were smokers, 66 (38.8%) diabetic and 79 (46.5%) hypertensive patients. Eosinophilia was diagnosed in 37 (21.8%) patients. Conclusion: Based on the data of our study including 170 patients hospitalized for AECOPD, we found that 21.8% patients had blood eosinophilia (defined as ≥300 cells/μL). So Peripheral blood eosinoph...
Circulating eosinophil levels do not predict severe exacerbations in COPD: a retrospective study
ERJ Open Research, 2018
Whether the level of circulating eosinophils in chronic obstructive pulmonary disease (COPD) patients can predict the risk of exacerbations of COPD (ECOPD) or response to treatment is debated. Here, we evaluate the prevalence of elevated eosinophils in COPD patients and its relationship with severe ECOPD requiring hospitalisation.We retrospectively reviewed the charts of COPD patients hospitalised in our centre between January 1, 2005 and November 30, 2015 because of ECOPD or other reasons (controls). In a second analysis, the ECOPD patients were divided into two subgroups based on having ECOPD in the next year after the index event or not. Circulating eosinophils, both during clinical stability and hospitalisation, as well as clinical and functional data and the relation to recurrent exacerbations were analysed.We studied 992 COPD patients (318 ECOPD patients and 674 controls). Among ECOPD patients, 121 had one or more ECOPD during the year after the index event. The prevalence of ...
Does eosinophilia and neutrophil to lymphocyte ratio affect hospital re-admission in cases of copD exacerbation? Introduction: We aimed to assess the relationship between peripheral eosinophilia and neutrophil/lymphocyte ratio with hospital admissions and re-admissions with chronic obstructive pulmonary disease (COPD) exacerbations. Materials and Methods: An observational cohort study was carried out in a tertiary teaching hospital. Subjects with previously diagnosed COPD and who were admitted as outpatients with acute exacerbations were included. The subjects' characteristics, complete blood count (CBC) parameters, neutrophil to lymphocyte rate (NLR), C-reactive protein (CRP), mean platelet volume (MPV) on admission and re-admission within the first 28 days. Patients were grouped according to their peripheral blood eosinophilia levels; group 1, > 2% (eosinophilic), group 2, ≤ 2% (non-eosinophilic or neutrophilic). The recorded data from the two groups were compared. results: 1490 eligible COPD subjects were enrolled. Approximately 42% were classified as eosinophilic. The non-eosinophilic group had a significantly higher leukocyte count, neutrophil percentage, and NLR than the eosinophilic group. The NLR value in patients with repeat re-admissions was higher than the average, i.e., 4.50 (p= 0.001). MPV and CRP measured on admission and re-admission were similar in both groups. The rate of hospital re-admission within 28 days was significantly higher in patients with a noneosinophilic attack. conclusion: When a patient is admitted to outpatients with a NLR greater than 4.50 and with a non-eosinophilic exacerbation they have an increased risk of re-admission in the first month. Higher NLR values and non-eosinophilic exacerbations may be helpful for the early detection of potential acute attacks in COPD patients, and may be indicators for antibiotic management.