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