High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis
Abstract Background In COPD, the course of the disease including morbidity and mortality is strongly associated with severe exacerbations. The current GOLD recommendations emphasize blood eosinophil counts as a marker for responsiveness to inhaled corticosteroids (ICS). Retrospective analyses from r...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12931-020-01365-5 |
| _version_ | 1818136096069910528 |
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| author | Timm Greulich Julia Tüffers Sina Mager Anna Eder Michael Maxheim Peter Alter Bernd Schmeck Claus F. Vogelmeier |
| author_facet | Timm Greulich Julia Tüffers Sina Mager Anna Eder Michael Maxheim Peter Alter Bernd Schmeck Claus F. Vogelmeier |
| author_sort | Timm Greulich |
| collection | DOAJ |
| description | Abstract Background In COPD, the course of the disease including morbidity and mortality is strongly associated with severe exacerbations. The current GOLD recommendations emphasize blood eosinophil counts as a marker for responsiveness to inhaled corticosteroids (ICS). Retrospective analyses from randomized clinical trials indicate a favorable response to systemic corticosteroids in exacerbated COPD patients with blood eosinophils > 2%, however data outside clinical trials are scarce. Patients and methods We retrospectively evaluated data from 1007 cases of patients who were admitted to the University Medical Center Marburg between 01/2013 and 12/2018. All patients had been diagnosed with an acute exacerbation of COPD (ICD-10 J44.0/J44.1). Our analysis was based on a subgroup of 417 patients in whom a full blood cell count was obtained at the day of admission. Patients were predominantly male (63.3%), had a median age of 74 years (IQR 65 years – 83 years) and a median FEV1 of 1.03 l (42.6% predicted). We compared the hospital length of stay and other outcome parameters using established thresholds for the eosinophil blood cell count (100 and 300 eosinophils/μl and 2%). Results Patients with low eosinophils (< 2%, <100 cells/μl) had a longer median time in hospital (length of hospital stay – LOS) as compared to patients with high eosinophils (< 2%: 9.31 vs. ≥2%:7 days, and < 100/μl: 10 vs. 100–300/μl: 8 vs. > 300/μl: 7 days). The median CRP was higher in patients with low eosinophils as compared to the other groups (< 2%: 22.7 vs. ≥2%: 9 mg/dl and < 100: 25 vs. 100–300: 13.5 vs. > 300: 7.1 mg/dl). Time to re-hospitalization or time to death did not differ between strata of eosinophils. Sensitivity analysis in a subgroup of patients in which pneumonia was excluded by chest x-ray did not significantly alter the results. Conclusion The results support the hypothesis that patients with severe COPD exacerbations and elevated blood eosinophil counts respond better to systemic corticosteroid treatment than patients with a non-eosinophilic exacerbation. |
| first_indexed | 2024-12-11T09:34:58Z |
| format | Article |
| id | doaj.art-26bc1c41d017420e822191fb3502f144 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-11T09:34:58Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-26bc1c41d017420e822191fb3502f1442022-12-22T01:12:53ZengBMCRespiratory Research1465-993X2020-05-012111810.1186/s12931-020-01365-5High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysisTimm Greulich0Julia Tüffers1Sina Mager2Anna Eder3Michael Maxheim4Peter Alter5Bernd Schmeck6Claus F. Vogelmeier7Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL)Abstract Background In COPD, the course of the disease including morbidity and mortality is strongly associated with severe exacerbations. The current GOLD recommendations emphasize blood eosinophil counts as a marker for responsiveness to inhaled corticosteroids (ICS). Retrospective analyses from randomized clinical trials indicate a favorable response to systemic corticosteroids in exacerbated COPD patients with blood eosinophils > 2%, however data outside clinical trials are scarce. Patients and methods We retrospectively evaluated data from 1007 cases of patients who were admitted to the University Medical Center Marburg between 01/2013 and 12/2018. All patients had been diagnosed with an acute exacerbation of COPD (ICD-10 J44.0/J44.1). Our analysis was based on a subgroup of 417 patients in whom a full blood cell count was obtained at the day of admission. Patients were predominantly male (63.3%), had a median age of 74 years (IQR 65 years – 83 years) and a median FEV1 of 1.03 l (42.6% predicted). We compared the hospital length of stay and other outcome parameters using established thresholds for the eosinophil blood cell count (100 and 300 eosinophils/μl and 2%). Results Patients with low eosinophils (< 2%, <100 cells/μl) had a longer median time in hospital (length of hospital stay – LOS) as compared to patients with high eosinophils (< 2%: 9.31 vs. ≥2%:7 days, and < 100/μl: 10 vs. 100–300/μl: 8 vs. > 300/μl: 7 days). The median CRP was higher in patients with low eosinophils as compared to the other groups (< 2%: 22.7 vs. ≥2%: 9 mg/dl and < 100: 25 vs. 100–300: 13.5 vs. > 300: 7.1 mg/dl). Time to re-hospitalization or time to death did not differ between strata of eosinophils. Sensitivity analysis in a subgroup of patients in which pneumonia was excluded by chest x-ray did not significantly alter the results. Conclusion The results support the hypothesis that patients with severe COPD exacerbations and elevated blood eosinophil counts respond better to systemic corticosteroid treatment than patients with a non-eosinophilic exacerbation.http://link.springer.com/article/10.1186/s12931-020-01365-5COPDEosinophilInfection and inflammation |
| spellingShingle | Timm Greulich Julia Tüffers Sina Mager Anna Eder Michael Maxheim Peter Alter Bernd Schmeck Claus F. Vogelmeier High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis Respiratory Research COPD Eosinophil Infection and inflammation |
| title | High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis |
| title_full | High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis |
| title_fullStr | High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis |
| title_full_unstemmed | High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis |
| title_short | High eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated COPD patients – a retrospective analysis |
| title_sort | high eosinophil blood counts are associated with a shorter length of hospital stay in exacerbated copd patients a retrospective analysis |
| topic | COPD Eosinophil Infection and inflammation |
| url | http://link.springer.com/article/10.1186/s12931-020-01365-5 |
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