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Baseline Blood Eosinophil Count and 28-Day in-Hospital Mortality in ICU-Admitted Patients with AECOPD: A Cohort Study
Zeqiang Wang1, Jianlong Tan1, Hanying Liu2
1Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, People's Republic of China.
Background:
Blood eosinophil count is widely used to guide corticosteroid decisions in stable chronic obstructive pulmonary disease (COPD) and non-ICU acute exacerbations of COPD (AECOPD), but its prognostic value and interpretation in ICU-admitted AECOPD remain uncertain.
Methods:
We conducted a retrospective cohort study using MIMIC-IV as the primary cohort and eICU-CRD for external validation. Adults with AECOPD were included if ICU admission occurred within 24 h of hospital admission and baseline eosinophil count was available within a predefined peri-ICU window. The primary outcome was 28-day in-hospital mortality after ICU admission. Baseline eosinophil count was analyzed per 100 cells/µL increase in prespecified multivariable Cox models.
Results:
The analytic cohorts included 645 patients from MIMIC-IV and 2503 from eICU-CRD. Twenty-eight-day in-hospital mortality was 14.3% and 6.7%, respectively. In MIMIC-IV, higher baseline eosinophil count was associated with a lower hazard of death (adjusted hazard ratio [HR] per 100 cells/µL: 0.58, 95% confidence interval [CI]: 0.39-0.85; P = 0.005). A similar association was observed in eICU-CRD (adjusted HR: 0.82, 95% CI: 0.72-0.93; P = 0.002). Categorical, competing-risk, and age-restricted analyses were broadly consistent with the primary findings, and restricted cubic splines did not identify a clear threshold.
Conclusion:
Among ICU-admitted patients with AECOPD who had clinically available baseline eosinophil measurements, higher baseline eosinophil count was associated with lower 28-day in-hospital mortality.
