Comparison of clinical characteristics and prognosis of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ZHANG Ying , JIANG Mingming , SUN Baohua

Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P. R. China;

Corresponding?author：

ZHANG Ying, Email: zhangying1023_2001@163.com

Keywords：

Chronic obstructive pulmonary disease; Eosinophilic; Neutrophilic; Prognosis

DOI：

10.7507/1671-6205.202004023

Video：

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Objective To explore the clinical characteristics and long term mortality of patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.Methods A retrospective review of the clinical data and long-term follow up was performed for 510 patients with first diagnosis of acute exacerbation of COPD (AECOPD) requiring hospital admission between January 2015 and December 2016. The follow-up was completed in January 1, 2020. These patients were divided into three groups according to routine blood test: an eosinophilic exacerbation group, with peripheral blood eosinophils >2%; a neutrophilic exacerbation group, with peripheral blood neutrophils >65% or leukocytes >11×10⁹/L; a paucigranulocytic exacerbation group, any case did not belong to the above two groups. The differences of clinical characteristics were compared among three groups. Cox regression model was used for analysis of independent risk factors of all-cause mortality of AECOPD patients.Results A total of 510 AECOPD patients were enrolled (180 eosinophilic, 273 neutrophilic and 57 paucigranulocytic, respectively). Compared with the neutrophilic exacerbation group, the eosinophilic exacerbation group had shorter time since onset of symptoms, the lower proportion of comorbid heart failure, the lower proportion of mechanical ventilation, dual antibiotics and systematic corticosteroid treatment, the shorter length of hospitalization and lower hospital mortality (all P<0.05). The average follow-up duration was 41 months for 485 AECOPD patients who completed long term follow-up. Compared with the eosinophilic exacerbation group, the neutrophilic exacerbation group was associated with a higher long-term mortality of AECOPD (HR=1.691, 95%CI 1.205 - 2.373, P=0.002).Conclusion COPD patients with neutrophilic exacerbations have more serious clinical features and higher mortality than those with eosinophilic exacerbations.

Citation： ZHANG Ying, JIANG Mingming, SUN Baohua. Comparison of clinical characteristics and prognosis of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 241-246. doi: 10.7507/1671-6205.202004023 Copy

1.	Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax, 2012, 67(11): 957-963.
2.	Bhowmik A, Seemungal TA, Sapsford RJ, et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax, 2000, 55(2): 114-120.
3.	Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon?. Proc Am Thorac Soc, 2004, 1(2): 109-114.
4.	Serafino-Agrusa L, Scichilone N, Spatafora M, et al. Blood eosinophils and treatment response in hospitalized exacerbations of chronic obstructive pulmonary disease: a case-control study. Pulm Pharmacol Ther, 2016, 37: 89-94.
5.	Saltürk C, Karakurt Z, Adiguzel N, et al. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?. Int J Chron Obstruct Pulmon Dis, 2015, 10: 1837-1846.
6.	Couillard S, Larivée P, Courteau J, et al. Eosinophils in COPD Exacerbations are associated with increased readmissions. Chest, 2017, 151(2): 366-373.
7.	Bafadhel M, Greening NJ, Harvey-Dunstan TC, et al. Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD. Chest, 2016, 150(2): 320-328.
8.	費凡, 吳楨珍, 朱曼旎, 等. 血嗜酸性粒細胞在慢性阻塞性肺疾病急性加重中的臨床意義. 中國呼吸與危重監護雜志, 2019, 18(5): 418-422.
9.	Casanova C, Celli BR, de-Torres JP, et al. Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD. Eur Respir J, 2017, 50(5): 1701162.
10.	Shin SH, Park HY, Kang D, et al. Serial blood eosinophils and clinical outcome in patients with chronic obstructive pulmonary disease. Respir Res, 2018, 19(1): 134.
11.	Turato G, Semenzato U, Bazzan E, et al. Blood eosinophilia neither reflects tissue eosinophils nor worsens clinical outcomes in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2018, 197(9): 1216-1219.
12.	王景, 陳碧, 朱述陽. 入院時外周血嗜酸粒細胞百分比與慢性阻塞性肺疾病急性加重患者出院后短期內急性加重復發的關系研究. 實用心腦肺血管病雜志, 2019, 27(7): 46-50.
13.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
14.	慢性阻塞性肺疾病急性加重(AECOPD)診治專家組. 慢性阻塞性肺疾病急性加重(AECOPD)診治中國專家共識(2014 年修訂版). 國際呼吸雜志, 2014, 34(1): 1-11.
15.	Kang HS, Rhee CK, Kim SK, et al. Comparison of the clinical characteristics and treatment outcomes of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2467-2473.
16.	Bafadhel M, McKenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
17.	Brightling CE, McKenna S, Hargadon B, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease. Thorax, 2005, 60(3): 193-198.
18.	Brightling CE, Monteiro W, Ward R, et al. Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial. Lancet, 2000, 356(9240): 1480-1485.
19.	Bafadhel M, McKenna S, Terry S, et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Am J Respir Crit Care Med, 2012, 186: 48-55.
20.	薛瑾, 崔亞楠, 陳平, 等. 血嗜酸粒細胞對慢性阻塞性肺疾病急性加重期激素治療反應性和再入院的預測價值. 中華結核和呼吸雜志, 2019, 42(6): 426-431.
21.	Oh YM, Lee KS, Hong Y, et al. Blood eosinophil count as a prognostic biomarker in COPD. Int J Chron Obstruct Pulmon Dis, 2018, 13: 3589-3596.
22.	Gil H, Magy N, Mauny F, et al. Value of eosinopenia in inflammatory disorders: an "old" marker revisited. Rev Med Interne, 2003, 24(7): 431-435.
23.	Steer J, Gibson J, Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax, 2012, 67(11): 970-976.
24.	Holland M, Alkhalil M, Chandromouli S. Eosinopenia as a marker of mortality and length of stay in patients admitted with exacerbations of chronic obstructive pulmonary disease. Respirology, 2010, 15(1): 165-167.
25.	Mendy A, Forno E, Niyonsenga T, et al. Blood biomarkers as predictors of long-term mortality in COPD. Clin Respir J, 2018, 12(5): 1891-1899.
26.	Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep, 2015, 5: 10961.
27.	張穎, 林英翔. 慢性阻塞性肺疾病急性加重住院患者一年及長期死亡風險因素分析. 中華結核和呼吸雜志, 2019, 42(12): 895-900.
28.	García-Sanz MT, Cánive-Gómez JC, Senín-Rial L, et al. One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease. J Thorac Dis, 2017, 9(3): 636-645.

1. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax, 2012, 67(11): 957-963.
2. Bhowmik A, Seemungal TA, Sapsford RJ, et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax, 2000, 55(2): 114-120.
3. Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon?. Proc Am Thorac Soc, 2004, 1(2): 109-114.
4. Serafino-Agrusa L, Scichilone N, Spatafora M, et al. Blood eosinophils and treatment response in hospitalized exacerbations of chronic obstructive pulmonary disease: a case-control study. Pulm Pharmacol Ther, 2016, 37: 89-94.
5. Saltürk C, Karakurt Z, Adiguzel N, et al. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?. Int J Chron Obstruct Pulmon Dis, 2015, 10: 1837-1846.
6. Couillard S, Larivée P, Courteau J, et al. Eosinophils in COPD Exacerbations are associated with increased readmissions. Chest, 2017, 151(2): 366-373.
7. Bafadhel M, Greening NJ, Harvey-Dunstan TC, et al. Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD. Chest, 2016, 150(2): 320-328.
8. 費凡, 吳楨珍, 朱曼旎, 等. 血嗜酸性粒細胞在慢性阻塞性肺疾病急性加重中的臨床意義. 中國呼吸與危重監護雜志, 2019, 18(5): 418-422.
9. Casanova C, Celli BR, de-Torres JP, et al. Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD. Eur Respir J, 2017, 50(5): 1701162.
10. Shin SH, Park HY, Kang D, et al. Serial blood eosinophils and clinical outcome in patients with chronic obstructive pulmonary disease. Respir Res, 2018, 19(1): 134.
11. Turato G, Semenzato U, Bazzan E, et al. Blood eosinophilia neither reflects tissue eosinophils nor worsens clinical outcomes in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2018, 197(9): 1216-1219.
12. 王景, 陳碧, 朱述陽. 入院時外周血嗜酸粒細胞百分比與慢性阻塞性肺疾病急性加重患者出院后短期內急性加重復發的關系研究. 實用心腦肺血管病雜志, 2019, 27(7): 46-50.
13. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
14. 慢性阻塞性肺疾病急性加重(AECOPD)診治專家組. 慢性阻塞性肺疾病急性加重(AECOPD)診治中國專家共識(2014 年修訂版). 國際呼吸雜志, 2014, 34(1): 1-11.
15. Kang HS, Rhee CK, Kim SK, et al. Comparison of the clinical characteristics and treatment outcomes of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2467-2473.
16. Bafadhel M, McKenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
17. Brightling CE, McKenna S, Hargadon B, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease. Thorax, 2005, 60(3): 193-198.
18. Brightling CE, Monteiro W, Ward R, et al. Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial. Lancet, 2000, 356(9240): 1480-1485.
19. Bafadhel M, McKenna S, Terry S, et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Am J Respir Crit Care Med, 2012, 186: 48-55.
20. 薛瑾, 崔亞楠, 陳平, 等. 血嗜酸粒細胞對慢性阻塞性肺疾病急性加重期激素治療反應性和再入院的預測價值. 中華結核和呼吸雜志, 2019, 42(6): 426-431.
21. Oh YM, Lee KS, Hong Y, et al. Blood eosinophil count as a prognostic biomarker in COPD. Int J Chron Obstruct Pulmon Dis, 2018, 13: 3589-3596.
22. Gil H, Magy N, Mauny F, et al. Value of eosinopenia in inflammatory disorders: an "old" marker revisited. Rev Med Interne, 2003, 24(7): 431-435.
23. Steer J, Gibson J, Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax, 2012, 67(11): 970-976.
24. Holland M, Alkhalil M, Chandromouli S. Eosinopenia as a marker of mortality and length of stay in patients admitted with exacerbations of chronic obstructive pulmonary disease. Respirology, 2010, 15(1): 165-167.
25. Mendy A, Forno E, Niyonsenga T, et al. Blood biomarkers as predictors of long-term mortality in COPD. Clin Respir J, 2018, 12(5): 1891-1899.
26. Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep, 2015, 5: 10961.
27. 張穎, 林英翔. 慢性阻塞性肺疾病急性加重住院患者一年及長期死亡風險因素分析. 中華結核和呼吸雜志, 2019, 42(12): 895-900.
28. García-Sanz MT, Cánive-Gómez JC, Senín-Rial L, et al. One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease. J Thorac Dis, 2017, 9(3): 636-645.

Chinese Journal of Respiratory and Critical Care Medicine

Comparison of clinical characteristics and prognosis of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD

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