Low and High Blood Eosinophil Counts as Biomarkers in Hospitalized Acute Exacerbations of COPD

Martin Ian MacDonald, Christian R. Osadnik, Lauren Bulfin, Kais Hamza, Paul Leong, Anders Wong, Paul T. King, Philip G. Bardin

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Characterizing acute exacerbations of COPD (AECOPD) and individualizing therapy is challenging. Key exacerbation therapies include antibiotics and systemic corticosteroids. Blood eosinophils, when either low or high, may offer a simple, inexpensive distinction to predict beneficial responses to these therapies. Methods: We conducted derivation (n = 242) and validation (n = 99) cohort studies of patients hospitalized for AECOPD. Patients who received oral corticosteroids before ED presentation were excluded. The derivation cohort was identified by individual case file review. The validation cohort was prospectively recruited during hospital admission. Exacerbations were grouped according to blood eosinophil count as low (<50/μL), normal (50-150/μL), or high (>150/μL). Exacerbations were classified as being associated with infection if either virus testing was positive or C-reactive protein was ≥20 mg/L. Associations of eosinophil groups with infection, hospital length of stay, and 12-month survival were compared using appropriate statistical methods. Results: There were no significant differences in baseline characteristics between patients with low, normal, or high blood eosinophils in either cohort. Eosinophil counts <50/μL were more strongly associated with infection (91% vs 51.9%, P = .001), distinguished patients with longer median hospital stays (7 vs 4 days, P < .001), and were associated with lower 12-month survival (82.4% vs 90.7%, P = .028; pooled data of both cohorts) than eosinophil counts >150/μL. Conclusions: Low and high blood eosinophil counts in hospitalized patients with AECOPD provide a practical clinical distinction that can potentially be used to inform management strategies. Prospective studies are needed to evaluate if this strategy can guide discriminate use of antibiotics and/or corticosteroids.

Original languageEnglish
Pages (from-to)92-100
Number of pages9
JournalChest
Volume156
Issue number1
DOIs
Publication statusPublished - 1 Jul 2019

Keywords

  • acute exacerbation of chronic bronchitis
  • COPD
  • eosinophils

Cite this

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title = "Low and High Blood Eosinophil Counts as Biomarkers in Hospitalized Acute Exacerbations of COPD",
abstract = "Background: Characterizing acute exacerbations of COPD (AECOPD) and individualizing therapy is challenging. Key exacerbation therapies include antibiotics and systemic corticosteroids. Blood eosinophils, when either low or high, may offer a simple, inexpensive distinction to predict beneficial responses to these therapies. Methods: We conducted derivation (n = 242) and validation (n = 99) cohort studies of patients hospitalized for AECOPD. Patients who received oral corticosteroids before ED presentation were excluded. The derivation cohort was identified by individual case file review. The validation cohort was prospectively recruited during hospital admission. Exacerbations were grouped according to blood eosinophil count as low (<50/μL), normal (50-150/μL), or high (>150/μL). Exacerbations were classified as being associated with infection if either virus testing was positive or C-reactive protein was ≥20 mg/L. Associations of eosinophil groups with infection, hospital length of stay, and 12-month survival were compared using appropriate statistical methods. Results: There were no significant differences in baseline characteristics between patients with low, normal, or high blood eosinophils in either cohort. Eosinophil counts <50/μL were more strongly associated with infection (91{\%} vs 51.9{\%}, P = .001), distinguished patients with longer median hospital stays (7 vs 4 days, P < .001), and were associated with lower 12-month survival (82.4{\%} vs 90.7{\%}, P = .028; pooled data of both cohorts) than eosinophil counts >150/μL. Conclusions: Low and high blood eosinophil counts in hospitalized patients with AECOPD provide a practical clinical distinction that can potentially be used to inform management strategies. Prospective studies are needed to evaluate if this strategy can guide discriminate use of antibiotics and/or corticosteroids.",
keywords = "acute exacerbation of chronic bronchitis, COPD, eosinophils",
author = "MacDonald, {Martin Ian} and Osadnik, {Christian R.} and Lauren Bulfin and Kais Hamza and Paul Leong and Anders Wong and King, {Paul T.} and Bardin, {Philip G.}",
year = "2019",
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Low and High Blood Eosinophil Counts as Biomarkers in Hospitalized Acute Exacerbations of COPD. / MacDonald, Martin Ian; Osadnik, Christian R.; Bulfin, Lauren; Hamza, Kais; Leong, Paul; Wong, Anders; King, Paul T.; Bardin, Philip G.

In: Chest, Vol. 156, No. 1, 01.07.2019, p. 92-100.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Low and High Blood Eosinophil Counts as Biomarkers in Hospitalized Acute Exacerbations of COPD

AU - MacDonald, Martin Ian

AU - Osadnik, Christian R.

AU - Bulfin, Lauren

AU - Hamza, Kais

AU - Leong, Paul

AU - Wong, Anders

AU - King, Paul T.

AU - Bardin, Philip G.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Characterizing acute exacerbations of COPD (AECOPD) and individualizing therapy is challenging. Key exacerbation therapies include antibiotics and systemic corticosteroids. Blood eosinophils, when either low or high, may offer a simple, inexpensive distinction to predict beneficial responses to these therapies. Methods: We conducted derivation (n = 242) and validation (n = 99) cohort studies of patients hospitalized for AECOPD. Patients who received oral corticosteroids before ED presentation were excluded. The derivation cohort was identified by individual case file review. The validation cohort was prospectively recruited during hospital admission. Exacerbations were grouped according to blood eosinophil count as low (<50/μL), normal (50-150/μL), or high (>150/μL). Exacerbations were classified as being associated with infection if either virus testing was positive or C-reactive protein was ≥20 mg/L. Associations of eosinophil groups with infection, hospital length of stay, and 12-month survival were compared using appropriate statistical methods. Results: There were no significant differences in baseline characteristics between patients with low, normal, or high blood eosinophils in either cohort. Eosinophil counts <50/μL were more strongly associated with infection (91% vs 51.9%, P = .001), distinguished patients with longer median hospital stays (7 vs 4 days, P < .001), and were associated with lower 12-month survival (82.4% vs 90.7%, P = .028; pooled data of both cohorts) than eosinophil counts >150/μL. Conclusions: Low and high blood eosinophil counts in hospitalized patients with AECOPD provide a practical clinical distinction that can potentially be used to inform management strategies. Prospective studies are needed to evaluate if this strategy can guide discriminate use of antibiotics and/or corticosteroids.

AB - Background: Characterizing acute exacerbations of COPD (AECOPD) and individualizing therapy is challenging. Key exacerbation therapies include antibiotics and systemic corticosteroids. Blood eosinophils, when either low or high, may offer a simple, inexpensive distinction to predict beneficial responses to these therapies. Methods: We conducted derivation (n = 242) and validation (n = 99) cohort studies of patients hospitalized for AECOPD. Patients who received oral corticosteroids before ED presentation were excluded. The derivation cohort was identified by individual case file review. The validation cohort was prospectively recruited during hospital admission. Exacerbations were grouped according to blood eosinophil count as low (<50/μL), normal (50-150/μL), or high (>150/μL). Exacerbations were classified as being associated with infection if either virus testing was positive or C-reactive protein was ≥20 mg/L. Associations of eosinophil groups with infection, hospital length of stay, and 12-month survival were compared using appropriate statistical methods. Results: There were no significant differences in baseline characteristics between patients with low, normal, or high blood eosinophils in either cohort. Eosinophil counts <50/μL were more strongly associated with infection (91% vs 51.9%, P = .001), distinguished patients with longer median hospital stays (7 vs 4 days, P < .001), and were associated with lower 12-month survival (82.4% vs 90.7%, P = .028; pooled data of both cohorts) than eosinophil counts >150/μL. Conclusions: Low and high blood eosinophil counts in hospitalized patients with AECOPD provide a practical clinical distinction that can potentially be used to inform management strategies. Prospective studies are needed to evaluate if this strategy can guide discriminate use of antibiotics and/or corticosteroids.

KW - acute exacerbation of chronic bronchitis

KW - COPD

KW - eosinophils

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U2 - 10.1016/j.chest.2019.02.406

DO - 10.1016/j.chest.2019.02.406

M3 - Article

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