Eosinopenia as a Prognostic Biomarker for Noninvasive Ventilation Use in COPD Exacerbations

Konstantinos Bartziokas; Evgenia Papathanasiou; Andriana I Papaioannou; Ilias Papanikolaou; Emmanouil Antonakis; Ioanna Makou; Georgios Hillas; Theodoros Karampitsakos; Ourania Papaioannou; Katerina Dimakou; Vasiliki Apollonatou; Galateia Verykokou; Spyros Papiris; Petros Bakakos; Stelios Loukides; Konstantinos Kostikas

doi:10.3390/jpm13040686

Eosinopenia as a Prognostic Biomarker for Noninvasive Ventilation Use in COPD Exacerbations

J Pers Med. 2023 Apr 19;13(4):686. doi: 10.3390/jpm13040686.

Authors

Konstantinos Bartziokas^{1

2}, Evgenia Papathanasiou², Andriana I Papaioannou², Ilias Papanikolaou³, Emmanouil Antonakis³, Ioanna Makou³, Georgios Hillas⁴, Theodoros Karampitsakos⁴, Ourania Papaioannou⁴, Katerina Dimakou⁴, Vasiliki Apollonatou², Galateia Verykokou², Spyros Papiris², Petros Bakakos⁵, Stelios Loukides², Konstantinos Kostikas¹

Affiliations

¹ Respiratory Medicine Department, University of Ioannina, 45110 Ioannina, Greece.
² 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 10679 Athens, Greece.
³ Respiratory Medicine Department, Corfu General Hospital, 49100 Corfu, Greece.
⁴ 5th Respiratory Medicine Department, Sotiria Chest Hospital, 11527 Athens, Greece.
⁵ 1st Respiratory Medicine Department, National and Kapodistrian University of Athens, 10676 Athens, Greece.

Abstract

Background: In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects. During an exacerbation of COPD, eosinopenia has been proposed as a prognostic marker of adverse outcomes.

Objectives: The aim of the present post hoc analysis was to elucidate the effectiveness of blood eosinophils for predicting the need of NIV in subjects with COPD exacerbation.

Methods: Consecutive subjects admitted to a hospital for COPD exacerbation were included in the analysis. The eosinophil count from the first complete blood count was used to designate the eosinophil groups. The relationship between the clinical characteristics and blood eosinophil counts, as dichotomized using 150 cells/μL, was evaluated. Results Subjects with blood eosinophil number < 150 k/μL had a more severe disease on admission compared to subjects with ≥150 k/μL, regarding pH 7.400 (7.36, 7.44) vs. 7.42 (7.38, 7.45), p = 0.008, PO₂/FiO₂ levels 238.1 (189.8, 278.6) vs. 276.2 (238.2, 305.6), p < 0.001, CRP (mg/L) levels 7.3 (3.1, 19.9) vs. 3.5 (0.7, 7.8), p < 0.001 and required a longer hospital stay (days) 10.0 (8.0, 14.0) vs. 5.0 (3.0, 7.0) p < 0.001 respectively. The number of blood eosinophils correlated with the levels of CRP upon admission (p < 0.001, r = -0.334), with arterial pH upon admission (p < 0.030, r = 0.121), with PO₂/FiO₂ (p < 0.001, r = -0.248), and with duration of hospital stay (p < 0.001, r = -0.589). In the multinomial logistic regression analysis, blood eosinophil count < 150 k/μL was an independent predictor of the use of NIV during hospital stay.

Conclusion: During COPD exacerbation, low blood eosinophil levels upon admission are related to more severe disease and can be used as a predictor of the need of NIV. Further prospective studies are needed to identify the use of blood eosinophil levels as a predictor of unfavorable outcomes.

Keywords: COPD; eosinophils; exacerbations; hospital admission; non-invasive ventilation.

Grants and funding

This research received no external funding.