Hendrik J Prins1, Ruud Duijkers2, Rene Lutter3, Johannes M Daniels4, Paul van der Valk5, Margreet Schoorl6, Huib A Kerstjens7, Tjip S van der Werf7, Wim G Boersma2. 1. Department Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands. Electronic address: hjprins1982@hotmail.com. 2. Department Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands. 3. Departments of Experimental Immunology and Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. 5. Department of Pulmonary Diseases, Medic Spectrum Twente, Enschede, The Netherlands. 6. Department of Clinical Chemistry, Haematology & Immunology, Northwest Clinics, Alkmaar, The Netherlands. 7. University of Groningen, Department of Pulmonary Diseases and Tuberculosis, University Medical Center, Groningen, The Netherlands.
Abstract
BACKGROUND:Blood eosinophilia is frequently encountered in patients with AECOPD. However the impact of blood eosinophilia at admission in patients with AECOPD on outcome on the short and long term has not been extensively studied which was the objective of the present study. METHODS: We used data of 207 exacerbations from a randomized clinical trial on antibiotic prescription based upon CRP-levels versus GOLD guided strategy and analyzed the impact of blood eosinophils (≥2% of total white cell count and eosinophil count ≥300 cell/microliter) on clinical outcome. RESULTS:207 patients were included of whom 39 (18·8%) hadeosinophilia ≥2%, 23 patients (11.1%) had blood eosinophil ≥300 cell/microliter. Eosinophilia was associated with shorter median length of stay in the eosinophilic groups(≥2% and ≥300 cell/microliter) compared to the non-eosinophilic groups. Early treatment failure was reduced in the both the eosinophilic groups (≥2% and ≥300 cell/microliter). Late treatment failure (day 11-30) did not differ between the groups. Relapse, was more frequent the eosinophilic groups (≥2% and ≥300 cell/microliter), however in the latter group this did not reach statistical significance. Eosinophilia ≥2% was a risk factor for having relapse (eosinophilia ≥2%: HR = 2·351; 95%CI 1·335-4·139), whereas eosinophilia <2% was associated with a lower risk factor for having early treatment failure (HR = 0·339 95%CI 0·122-0·943). CONCLUSION: We showed that blood eosinophilia at admission in patients with an AECOPD is associated with higher short-term treatment success rate. However, blood eosinophilia ≥2% predicts a less favorable outcome due to an increased risk of relapse. CLINICAL TRIAL REGISTRATION: NCT01232140.
RCT Entities:
BACKGROUND:Blood eosinophilia is frequently encountered in patients with AECOPD. However the impact of blood eosinophilia at admission in patients with AECOPD on outcome on the short and long term has not been extensively studied which was the objective of the present study. METHODS: We used data of 207 exacerbations from a randomized clinical trial on antibiotic prescription based upon CRP-levels versus GOLD guided strategy and analyzed the impact of blood eosinophils (≥2% of total white cell count and eosinophil count ≥300 cell/microliter) on clinical outcome. RESULTS: 207 patients were included of whom 39 (18·8%) had eosinophilia ≥2%, 23 patients (11.1%) had blood eosinophil ≥300 cell/microliter. Eosinophilia was associated with shorter median length of stay in the eosinophilic groups(≥2% and ≥300 cell/microliter) compared to the non-eosinophilic groups. Early treatment failure was reduced in the both the eosinophilic groups (≥2% and ≥300 cell/microliter). Late treatment failure (day 11-30) did not differ between the groups. Relapse, was more frequent the eosinophilic groups (≥2% and ≥300 cell/microliter), however in the latter group this did not reach statistical significance. Eosinophilia ≥2% was a risk factor for having relapse (eosinophilia ≥2%: HR = 2·351; 95%CI 1·335-4·139), whereas eosinophilia <2% was associated with a lower risk factor for having early treatment failure (HR = 0·339 95%CI 0·122-0·943). CONCLUSION: We showed that blood eosinophilia at admission in patients with an AECOPD is associated with higher short-term treatment success rate. However, blood eosinophilia ≥2% predicts a less favorable outcome due to an increased risk of relapse. CLINICAL TRIAL REGISTRATION: NCT01232140.
Authors: Maryse Bélanger; Simon Couillard; Josiane Courteau; Pierre Larivée; Thomas G Poder; Nathalie Carrier; Kim Girard; Felix-Antoine Vézina; Alain Vanasse Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-10-01
Authors: Thomas G Poder; Nathalie Carrier; Maryse Bélanger; Simon Couillard; Josiane Courteau; Pierre Larivée; Alain Vanasse Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-10-08