Predictive Value of the Baseline and Early Changes in Blood Eosinophils for Short-Term Mortality in Patients with Acute Respiratory Distress Syndrome

Abstract

Background

Eosinophils play an essential role in the pathogenesis of acute respiratory distress syndrome (ARDS). We aimed to assess the association between the baseline blood eosinophils, eosinophil changes during the first week in the intensive care unit (ICU) and short-term patient outcomes.

Methods

All patients meeting the Berlin definition of ARDS from the Medical Information Mart for Intensive Care IV database were retrospectively analyzed. We used logistic regression, Kaplan–Meier survival and random forest analysis to determine the association between the baseline eosinophils and short-term mortality. Then the trends in eosinophils over time were compared between the survivors and non-survivors using a generalized additive mixed model (GAMM), which is a common approach used for analysis of repeated measurement data. Area under the receiver-operating characteristic curve (AUC) was used to evaluate the predictive value.

Results

A total of 1685 patients were included, and the 30-day mortality was 25.1%. Kaplan–Meier analysis showed that patients with high baseline eosinophils (>0.3%) had lower 30-day mortality (p < 0.001). Random forest model selected the baseline eosinophils as an important factor associated with 30-day mortality. Multivariable logistic regression analysis identified high baseline eosinophils as an independent factor for 30-day mortality (OR 0.743, 95% CI 0.568–0.970). The GAMM result showed that the levels of eosinophils were increased in both survival and non-survival groups, and the between-group differences increased over time, with an average of 0.154 daily after adjusting for confounders. The AUC of changes in eosinophils within the first week was significantly higher than that of baseline eosinophils.

Conclusion

There is a negative association between the baseline eosinophils and short-term mortality in ARDS patients, and the differences in eosinophils increased over time between the survivors and non-survivors. Higher increase in eosinophils is associated with decreased short-term mortality, and dynamic monitoring of eosinophils could better predict the survival of ARDS patients.

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Keywords:

• ARDS
• eosinophils
• 30-day mortality
• generalized additive mixed model
• change

Abbreviations

APS III, Acute Physiology Score III; ARDS, acute respiratory distress syndrome; AUC, area under the curve; BMI, body mass index; BUN, blood urea nitrogen; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRRT, continuous renal replacement therapy; ECP, eosinophil cationic protein; GAMM, generalized additive mixed model; ICU, intensive care unit; IQR, interquartile range; LODS, Logistic Organ Dysfunction System; LOS, length of hospital stay; LPS, lipopolysaccharide; MAP, mean arterial pressure; MIMIC, Medical Information Mart for Intensive Care; OASIS, Oxford Acute Severity of Illness Score; OR, odds ratio; PaO2/FiO2, arterial oxygen partial pressure/fraction of inspired oxygen; PEEP, positive end-expiratory pressure; ROC, receiver operating characteristic; RR, respiratory rate; SD, standard deviation; WBC, white blood cells.

Ethics Approval and Consent to Participate

The establishment of this database was approved by the Institutional Review Boards of the Massachusetts Institute of Technology, and consent was obtained for the original data collection. The study was reviewed and considered exempt by the Ethics Committees of the Second Affiliated Hospital of Chongqing Medical University (NO. 2021-113).

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this paper.