Scripties UMCG - Rijksuniversiteit Groningen
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“Eosinophilia in severe COPD exacerbations and its association with morbidity and mortality”

(2017) Berkenbos, E. (Elias)

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with airway inflammation, high prevalence of exacerbations and increased risk for mortality. In a subset of patients with COPD underlying eosinophilic inflammation is present. The role of eosinophils in COPD however is not yet fully understood and contradictory results have been reported. The goal of this study was to investigate the association of elevated eosinophil count at time of hospitalisation for an acute exacerbation of COPD (AECOPD) with morbidity and mortality risk in COPD.
METHODS: 443 patients of the Cohort of Mortality and Inflammation in COPD (COMIC) study had been included at time of hospitalisation for AECOPD. Three thresholds (≥200, ≥300cells/μL and ≥2% of total leucocyte count) for eosinophil count were used to divide the patients into the eosinophilic or non-eosinophilic exacerbation group. Outcome parameters are 3-year survival, based on all-cause mortality, time until first hospitalisation for an AECOPD and time until first community-acquired pneumonia (CAP).
RESULTS: Exacerbations with eosinophilia, depending on the threshold, occurred in 15-28% of the patients included. Eosinophilia, defined as ≥2% of total leucocyte count in blood, was associated with a reduced risk of 3-year all-cause mortality in univariate analysis , (hazard ratio (HR), 0.643 [95%CI 0.43-0.97]; p=0.035), however after correction for the confounder age this association disappeared in multivariate analysis (cHR 0.88 [95% CI 0.58-1.34]; p=0.559). Eosinophilia was associated with a shorter time to first new hospitalisation for AECOPD (cHR, 1.43 [1.04-1.98]; p=0.029). No association was found between any of the three thresholds for eosinophilia and time until first CAP.
CONCLUSIONS: Eosinophilia, defined as ≥2% of total leucocyte count, at the time of an acute exacerbation of COPD was associated with a significant increased risk for a new severe exacerbation. In univariate analyses this threshold was associated with better survival, however after correction for the confounders this association was no longer significant.

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