Low Eosinophil Phenotype Predicts Noninvasive Mechanical Ventilation Use in Patients with Hospitalized Exacerbations of COPD

Tingting Wei; Xiaocen Wang; Ke Lang; Cuicui Chen; Yansha Song; Jinlong Luo; Zhaolin Gu; Xianglin Hu; Dong Yang

doi:10.2147/JIR.S343918

Low Eosinophil Phenotype Predicts Noninvasive Mechanical Ventilation Use in Patients with Hospitalized Exacerbations of COPD

J Inflamm Res. 2022 Feb 24:15:1259-1271. doi: 10.2147/JIR.S343918. eCollection 2022.

Authors

Tingting Wei^#¹, Xiaocen Wang^#¹, Ke Lang^#¹, Cuicui Chen¹, Yansha Song¹, Jinlong Luo¹, Zhaolin Gu¹, Xianglin Hu¹, Dong Yang¹

Affiliation

¹ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.

^# Contributed equally.

Abstract

Rationale: Eosinophilic inflammation is related to the progression and outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Till now, few studies have focused on low EOS in AECOPD.

Objective: To reveal the clinical characteristics, therapeutic responses and prognosis of patients hospitalized of AECOPD with low EOS.

Methods: The electronic database of Zhongshan Hospital, Fudan University was used. Cohort 1 included 608 patients with hospitalized AECOPD. Study population 2 consisted of 166 patients with AECOPD admission at least twice. Impact of low EOS on NIMV treatment, length of hospital stays and 12-month AECOPD-related readmission were analyzed with multivariable logistic regression model. Thirty-five hospitalized AECOPD patients were prospectively recruited as cohort 3 to explore the association between EOS and other immune cells using Spearman correlation coefficient for ranked data.

Results: EOS level was suppressed on admission in AECOPD patients, and significantly improved after hospitalized treatment (P < 0.05). For inflammatory markers, leucocytes, neutrophils and lactate dehydrogenase levels were higher, while lymphocytes, monocytes and interleukin-6 levels were lower in the low-EOS group than those in the non-low EOS group (P < 0.05). Low EOS (EOS < 50 cells/μL) was an independent risk factor of NIMV use (OR = 1.86, 95% CI = 1.26 ~ 2.73). The EOS percentage was positively correlated with the T cell percentage (r = 0.46, P < 0.05) and negatively correlated with the natural killer cell percentage (r = -0.39, P < 0.05). The patients with low EOS had lower level of CD4⁺ T cell (P < 0.05) than that of patients with non-low EOS.

Conclusion: Low EOS might be a stable phenotype in patients with hospitalized AECOPD and could be used to inform NIMV management, hyperinflammatory state and impaired immunity situation.

Keywords: acute exacerbation; chronic obstructive pulmonary disease; eosinophilic inflammation; noninvasive mechanical ventilation; prognostic phenotype.

Grants and funding

This work was supported, in part, by National Natural Science Foundation of China (project number 81970069; 82170091); Smart Healthcare Project of Zhongshan Hospital, Fudan University (project number 2020ZHZS18).