Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?

Figures & data

Figure 1 Flowchart of patient enrollment.

Abbreviations: ARF, acute respiratory failure; CBC, complete blood count; ICU, intensive care unit.

Table 1 Demographics and ICU values of study groups

	Group 1 (n=62)	Group 2 (n=585)	P-value
Age, years, median (IQR)	67 (54–78)	69 (60–77)	0.21
Sex, male, n (%)	51 (82.3)	472 (80.7)	0.28
Body mass index, kg/m^2, median (IQR)	23 (19–26)	23 (20–29)	0.32
Smoke exposure, n (%)
Active cigarette smoker	26 (41.9)	206 (35.2)	0.50
Ex-cigarette smoker	15 (24.2)	177 (30.3)	na
Smoke other than cigarette	21 (33.4)	202 (34.5)	na
Biomass exposure	19 (30.6)	150 (25.6)	0.39
Pack-years, median (IQR)	40 (30–60)	43 (30–60)	0.77
Comorbid diseases, n (%)
Diabetes mellitus	15 (24)	112 (19)	0.35
Hypertension	20 (32)	231 (40)	0.26
Congestive heart failure	20 (32)	193 (33)	0.89
Arrhythmia	19 (31)	107 (18)	0.02
Malignancy	9 (15)	59 (10)	0.28
Chronic renal diseases	2 (3)	22 (4)	0.83
Long-term oxygen therapy	35 (57)	303 (52)	0.52
Long-term home NIMV	27 (44)	175 (30)	0.031
Pre-ICU location, n (%)
Ward	19 (31.7)	253 (46.7)	0.001
Emergency department	25 (41.7)	273 (46.7)	na
Outpatient clinic	9 (15.0)	19 (3.3)	na
Other ICU	7 (11.7)	39 (6.7)	na
Pre-ICU ward day, median (IQR)	5 (4–10)	3 (1–6)	0.001
ICU data
APACHE II, median (IQR)	17 (12–24)	20 (16–25)	0.002
Sepsis, n (%)	18 (29)	220 (38)	0.17
Septic shock, n (%)	6 (10)	123 (21)	0.032
Culture performed, n (%)	28 (45)	302 (52)	0.31
Resistant pathogen n (%)	1 (1.6)	104 (28)	0.001
Arterial blood gas on admission
pH	7.40 (7.30–7.44)	7.30 (7.24–7.38)	0.001
PaCO2, mmHg	53 (36–68)	65 (45–81)	0.005
PaO2/FiO2	169 (114–352)	180 (120–258)	0.61
HCO3, mmol	29 (25–35)	30 (24–36)	0.72
SatO2%	95 (89–98)	95 (90–98)	0.97
Mechanical ventilation
NIMV, n (%)	33 (53)	435 (75)	0.001
NIMV days, median (IQR)	3 (2–6)	4 (2–7)	0.11
NIMV failure to IMV, n (%)	10 (16)	189 (32)	0.008
IMV, n (%)	31 (50)	274 (47)	0.65
IMV days, n (%)	2 (1–6)	3 (1–7)	0.17
Length of ICU stay, days, median (IQR)	4 (2–7)	6 (3–9)	0.002
ICU mortality, n (%)	8 (12.9)	146 (24.9)	0.034

Note: Eosinophilic COPD group 1 (peripheral blood eosinophil count >2%), non-eosinophilic COPD group 2 (peripheral blood eosinophil count ≤2%).

Abbreviations: ICU, intensive care unit; NIMV, noninvasive mechanical ventilation; IMV, invasive mechanical ventilation; IQR, interquartile range: 25%–75%; na, not applicable.

Figure 2 Respiratory treatment approach and outcome for study groups.

Abbreviations: ARF, acute respiratory failure; ICU, intensive care unit; IMV, invasive mechanical ventilation; NIMV, noninvasive mechanical ventilation.

Table 2 Complete blood count values of study groups on admission to and discharge from the ICU

	Admission			Discharge
	Group 1 (n=62)	Group 2 (n=585)	P-value	Group 1 (n=62)	Group 2 (n=585)	P-value
Leucocyte count, 10^9 L	8.9 (7.0–12.5)	11.1 (8.2–15.4)	0.001	8.7 (7.2–10.8)	9.7 (7.1–12.9)	0.11
Neutrophil, %	72 (67–79)	87 (80–92)	0.001	70 (62–76)	79 (70–86)	0.001
Monocyte, %	6.7 (4.8–8.7)	4.8 (2.7–7.5)	0.001	6.5 (5.0–8.5)	6.7 (4.5–9.3)	0.64
Lymphocyte, %	15.8 (11.9–20.5)	6.7 (3.9–11.0)	0.001	18.7 (12.1–23.5)	11.6 (6.8–17.9)	0.001
Eosinophil, %	2.87 (2.30–4.20)	0.20 (0.03–0.80)	0.001	3.87 (2.10–7.00)	0.90 (0.17–2.10)	0.001
Basophil, %	0.40 (0.20–0.68)	0.15 (0.07–0.40)	0.001	0.31 (0.10–0.60)	0.20 (0.10–0.50)	0.09
Erytrocyte count, 10^12 L	3.9 (3.5–4.2)	4.32 (3.82–4.87)	0.001	3.8 (3.4–4.2)	4.05 (3.51–4.65)	0.003
Hemoglobin, g/dL	10.7 (9.7–12.3)	12.1 (10.7–13.5)	0.001	10.4 (9.3–12.0)	11.4 (10.0–12.0)	0.012
Hematocrit, %	34.3 (29.7–37.6)	37.4 (33.2–42.3)	0.001	32.3 (29.0–35.9)	35.2 (30.6–39.7)	0.003
MCV, fL	87 (82–92)	87 (82–91)	0.99	88 (83–92)	87 (82–91)	0.64
Platelet count, 10^9 L	267 (213–377)	236 (183–308)	0.004	261 (197–337)	219 (165–284)	0.001
MPV, fL	8.5 (7.6–9.1)	8.8 (8.2–9.6)	0.003	8.8 (8.1–9.4)	9.1 (8.3–9.9)	0.013

Note: Eosinophilic COPD group 1 (peripheral blood eosinophil count >2%), non-eosinophilic COPD group 2 (peripheral blood eosinophil count ≤2%). Data is presented as median (IQR).

Abbreviations: ICU, intensive care unit; MCV, mean corpuscular volume; MPV, mean platelet volume.

Table 3 Comparison of complete blood count values on admission and discharge for each group

	Group 1 (n=62)			Group 2 (n=585)
	Admission	Discharge	P-value	Admission	Discharge	P-value
Leucocyte count, 10^9 L	8.9 (7.0–12.5)	8.7 (7.2–10.8)	0.16	11.1 (8.2–15.4)	9.7 (7.1–12.9)	0.001
Neutrophil, %	72 (67–79)	70 (62–76)	0.83	87 (80–92)	79 (70–86)	0.001
Monocyte, %	6.7 (4.8–8.7)	6.5 (5.0–8.5)	0.61	4.8 (2.7–7.5)	6.7 (4.5–9.3)	0.001
Lymphocyte, %	15.8 (11.9–20.5)	18.7 (12.1–23.5)	0.54	6.7 (3.9–11.0)	11.6 (6.8–17.9)	0.001
Eosinophil, %	2.87 (2.30–4.20)	3.87 (2.10–7.00)	0.64	0.20 (0.03–0.80)	0.90 (0.17–2.10)	0.001
Basophil, %	0.40 (0.20–0.68)	0.31 (0.10–0.60)	0.027	0.15 (0.07–0.40)	0.20 (0.10–0.50)	0.001
Erythrocyte count, 10^12 L	3.9 (3.5–4.2)	3.8 (3.4–4.2)	0.002	4.32 (3.82–4.87)	4.05 (3.51–4.65)	0.001
Hemoglobin, g/dL	10.7 (9.7–12.3)	10.4 (9.3–12.0)	0.002	12.1 (10.7–13.5)	11.4 (10.0–12.0)	0.001
Hematocrit, %	34.3 (29.7–37.6)	32.3 (29.0–35.9)	0.001	37.4 (33.2–42.3)	35.2 (30.6–39.7)	0.001
MCV, fL	87 (82–92)	88 (83–92)	0.86	87 (82–91)	87 (82–91)	0.21
Platelet count, 10^9 L	267 (213–377)	261 (197–337)	0.56	236 (183–308)	219 (165–284)	0.001
Mean platelet volume	8.5 (7.6–9.1)	8.8 (8.1–9.4)	0.001	8.8 (8.2–9.6)	9.1 (8.3–9.9)	0.001

Note: Eosinophilic COPD group 1 (peripheral blood eosinophil count >2%), non-eosinophilic COPD group 2 (peripheral blood eosinophil count ≤2%). Data is presented as median (IQR).

Abbreviations: MCV, mean corpuscular volume; ICU, intensive care unit.

Table 4 On the day of admission to and discharge from the ICU for CRP, neutrophil to lymphocyte ratio and platelet to MPV ratio and delta values of study groups

	Group 1	Group 2	P-value
CRP, mg/dL on admission to the ICU	39.3 (14.1–100.0)	52.7 (16.7–128.0)	0.24
CRP, mg/dL discharge from ICU	41.5 (18.0–89.0)	43.0 (17.0–98.0)	0.59
CRP, mg/dL maximum value in the ICU	65.5 (24.0–155.0)	105.0 (35.8–184.0)	0.06
Neutrophil to lymphocyte ratio on admission to the ICU	4.6 (3.2–6.8)	13.0 (7.3–23.1)	0.001
Neutrophil to lymphocyte ratio discharge from ICU	3.7 (2.7–6.6)	6.8 (4.0–12.6)	0.001
Platelet to MPV ratio on admission to the ICU	30.7 (22.6–47.3)	26.3 (19.6–40.0)	0.002
Platelet to MPV ratio discharge from ICU	30.6 (21.7–45.0)	24.0 (17.2–33.0)	0.001
Delta neutrophil to lymphocyte ratio	0.29 (−1.0–2.1)	4.4 (0.0–12.6)	0.001
Delta platelet to MPV ratio	1.32 (−2.2–6.0)	1.8 (−1.8–7.9)	0.42
Delta CRP, mg/dL	0.0 (0.0–12.4)	0.0 (0.0–53.7)	0.049
Antibiotic usage, n (%)	51 (82.3%)	540 (92.5%)	0.006
Steroid usage, n (%)	4 (6.5%)	168 (28.9%)	0.0001

Notes: Eosinophilic COPD group 1 (peripheral blood eosinophil count >2%), non-eosinophilic COPD group 2 (peripheral blood eosinophil count ≤2%). Delta: values on ICU admission minus values on ICU discharge. Data is presented as median (IQR).

Abbreviations: CRP, C-reactive protein; ICU, intensive care unit; MPV, mean platelet volume.

Table 5 Logistic regression analysis of intensive care mortality risk factors of COPD patients with acute respiratory failure

	Odds ratio	95% confidence interval		P-value
		Lower	Upper
Presence of septic shock	4.20	2.21	7.99	0.001
Presence of arrhythmia	2.50	1.34	4.67	0.004
Being age 80 years and above	2.37	1.29	4.63	0.012
Presence of infection with resistant pathogen	2.12	1.12	3.99	0.020
IMV application	2.10	1.09	4.04	0.027
NLR equal and above 16	1.96	1.13	3.39	0.016
CRP 50 mg/dL and above	1.78	1.01	3.14	0.047
Home NIMV use	0.33	0.17	0.64	0.001

Abbreviations: CRP, C-reactive protein; IMV, invasive mechanical ventilation; NIMV, noninvasive mechanical ventilation; NLR, neutrophil to lymphocyte ratio.