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Lookup NU author(s): Dr Carlos Echevarria, Dr John Steer, Dr Arun Prasad, Professor Stephen BourkeORCiD
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© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.Background: Blood eosinophil counts have been studied in patients with stable chronic obstructive pulmonary disease (COPD) and are a useful biomarker to guide inhaled corticosteroid use. Less is known about eosinophil counts during severe exacerbation. Methods: In this retrospective study, 2645 patients admitted consecutively with COPD exacerbation across six UK hospitals were included in the study, and the clinical diagnosis was confirmed by a respiratory specialist. The relationship between admission eosinophil count, inpatient death and 1-year death was assessed. In a backward elimination, Poisson regression analysis using the log-link function with robust estimates, patients' markers of acute illness and stable-state characteristics were assessed in terms of their association with eosinopenia. Results: 1369 of 2645 (52%) patients had eosinopenia at admission. Those with eosinopenia had a 2.5-fold increased risk of inpatient death compared with those without eosinopenia (12.1% vs 4.9%, RR=2.50, 95% CI 1.88 to 3.31, p<0.001). The same mortality risk with eosinopenia was seen among the subgroup with pneumonic exacerbation (n=788, 21.3% vs 8.5%, RR=2.5, 95% CI 1.67 to 2.24, p<0.001). In a regression analysis, eosinopenia was significantly associated with: older age and male sex; a higher pulse rate, temperature, neutrophil count, urea and C reactive protein level; a higher proportion of patients with chest X-ray consolidation and a reduced Glasgow Coma Score; and lower systolic and diastolic blood pressure measurements and lower oxygen saturation, albumin, platelet and previous admission counts. Discussion: During severe COPD exacerbation, eosinopenia is common and associated with inpatient death and several markers of acute illness. Clinicians should be cautious about using eosinophil results obtained during severe exacerbation to guide treatment decisions regarding inhaled corticosteroid use.
Author(s): Echevarria C, Steer J, Prasad A, Quint JK, Bourke SC
Publication type: Article
Publication status: Published
Journal: Thorax
Year: 2023
Volume: 78
Issue: 11
Pages: 1090-1096
Online publication date: 24/07/2023
Acceptance date: 16/06/2023
ISSN (print): 0040-6376
ISSN (electronic): 1468-3296
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/thorax-2022-219463
DOI: 10.1136/thorax-2022-219463
PubMed id: 37487711
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