Association Between Blood Eosinophils and Mortality in Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study
Authors Yang J, Yang J
Received 19 November 2020
Accepted for publication 25 January 2021
Published 11 February 2021 Volume 2021:16 Pages 281—288
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Jia Yang,1 Junchao Yang2
1The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
Correspondence: Junchao Yang
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou City, Zhejiang Province, People’s Republic of China
Purpose: To explore the relationship between the blood eosinophil concentrations in the early stage and mortality in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease.
Methods: Patient data were extracted from the MIMIC-III V1.4 database. Only the acute exacerbation of chronic obstructive pulmonary disease patients with the first measurement time of blood eosinophil concentrations (%) between 24 hours before admission and 24 hours after admission was included. The logistic regression model was used to analyze the association between eosinophil and outcomes.
Results: 1019 patients were included in the study. Two multivariate regression models were built. The adjusted odds ratio of in-hospital mortality, in-ICU mortality, hospital length of stay and ICU length of stay for initial blood eosinophil concentrations in model 1 (adjusted for SAPS Ⅱ, cardiac arrhythmias, solid tumor, metastatic cancer, liver disease, neutrophils) were 0.792 (95% CI: 0.643– 0.976, p=0.028), 0.812 (95% CI: 0.645– 1.022, p=0.076), 0.847 (95% CI: 0.772– 0.930, p=0.001) and 0.914 (95% CI: 0.836– 1.000, p=0.049) respectively. Meanwhile, in model 2 (adjusted for SOFA score, age, cardiac arrhythmias, solid tumor, metastatic cancer, liver disease, neutrophils) ORs were 0.785 (95% CI: 0.636– 0.968, p=0.024), 0.807 (95% CI: 0.641– 1.016, p=0.068), 0.854 (95% CI: 0.778– 0.939, p=0.001) and 0.917 (95% CI: 0.838– 1.004, p=0.060) respectively. The area under the ROC curve for eosinophil initial was 0.608 (95% CI: 0.559– 0.657). The discriminatory eosinophil thresholds were 0.35% (sensitivity=0.59, specificity=0.61) for in-hospital mortality.
Conclusion: Increased blood eosinophils were associated with decreased in-hospital mortality and shorten hospital length of stay in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease. A discriminatory eosinophil threshold of 0.35% for mortality was found, but further studies were needed to verify it.
Keywords: chronic obstructive pulmonary disease, exacerbation, eosinophil, mortality, critical care
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