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. 2020 Mar;25(3):259-266.
doi: 10.1111/resp.13660. Epub 2019 Aug 6.

Blood eosinophil count as a predictor of hospital length of stay in COPD exacerbations

Fanny W S Ko  1 , Ka Pang Chan  1 , Jenny Ngai  1 , So-Shan Ng  1 , Wing Ho Yip  1 , April Ip  1 , Tat-On Chan  1 , David S C Hui  1
Affiliations

Blood eosinophil count as a predictor of hospital length of stay in COPD exacerbations

Fanny W S Ko et al. Respirology. 2020 Mar.

Abstract

Background and objective: Airway inflammation accompanying exacerbations varies among individuals with some having neutrophilic, while others showing eosinophilic inflammation. This study assessed the cut-off values of blood eosinophil count for identifying subjects with longer hospital length of stay (LOS) with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods: Patients were recruited at presentation to the hospital with an AECOPD. Complete blood picture with differential count was taken on admission. Patients were treated with a standard course of systemic corticosteroid and antibiotic and evaluated at 8 weeks post-exacerbation for lung function measurement and 6-min walk. They were followed up in 1 year for any readmissions or mortality. Cut-off values of eosinophils for assessment of longer LOS were calculated using receiver operating characteristic (ROC) curve analysis.

Results: A total of 346 patients with admission eosinophil count were included in the analysis (333 (96.2%) were males; mean ± SD age: 74.9 ± 7.8 years; mean forced expiratory volume in 1 s (FEV1 ): 43.4 ± 16.3% predicted). The median (interquartile range (IQR)) of the absolute peripheral eosinophil count, percent eosinophil count and LOS were 0.11 (0.25) × 109 /L, 1 (3) % and 5 (7) days, respectively. Using the median LOS of ≥5 days as the cut-off, ROC analysis of the cut-off value of eosinophil count associated with longer LOS was at <2% (area under the curve (AUC): 0.666, P < 0.001) while absolute eosinophil count was at <0.144 × 109 /L (AUC: 0.645, P < 0.001). These eosinophil cut-off values could predict longer LOS independent of age, lung function and previous hospital admissions, but had no association with readmissions for AECOPD and mortality at 12 months.

Conclusion: An eosinophil value of <0.144 × 109 /L on admission or <2% was associated with longer hospital LOS for AECOPD.

Trial registration: ClinicalTrials.gov NCT02815761.

Keywords: airway inflammation; chronic obstructive pulmonary disease; eosinophils; exacerbations.

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Comment in

  • COPD exacerbation phenotypes: The next frontier.
    Moran A, Pavord ID. Moran A, et al. Respirology. 2020 Mar;25(3):230-231. doi: 10.1111/resp.13693. Epub 2019 Aug 29. Respirology. 2020. PMID: 31468623 No abstract available.
  • Reply.
    Ko FWS, Chan KP, Ngai J, Ng SS, Yip WH, Chan TO, Hui DSC. Ko FWS, et al. Respirology. 2021 May;26(5):504-506. doi: 10.1111/resp.14024. Epub 2021 Mar 3. Respirology. 2021. PMID: 33660367 No abstract available.
  • Predictive value of blood eosinophil count in COPD.
    Zhu S, Lv X, Cai W. Zhu S, et al. Respirology. 2021 May;26(5):504. doi: 10.1111/resp.14025. Epub 2021 Mar 3. Respirology. 2021. PMID: 33660387 No abstract available.

References

REFERENCES

    1. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418-22.
    1. Donaldson GC, Seemungal T, Jeffries DJ, Wedzicha JA. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur. Respir. J. 1999; 13: 844-9.
    1. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957-63.
    1. Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, Yang IA. Acute exacerbation of COPD. Respirology 2016; 21: 1152-65.
    1. Bafadhel M, McKenna S, Terry S, Mistry V, Reid C, Haldar P, McCormick M, Haldar K, Kebadze T, Duvoix A et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am. J. Respir. Crit. Care Med. 2011; 184: 662-71.

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