COPD exacerbations with higher eosinophils associated with shorter length of stay

Patients with eosinophilic exacerbations are clinically indistinguishable from other patients with severe COPD exacerbations, but they may respond more rapidly to corticosteroid treatment.


A higher eosinophil count is associated with shorter length of stay for patients with severe COPD exacerbations, a new study found.

The new data came from a subgroup analysis of a large randomized controlled trial. It included 243 COPD patients with a mean age of 71 years. Their median absolute eosinophil count was 100 cells/µL, and the inpatient mortality rate was 3%. Results were published in the February CHEST.

A quarter of the studied patients had a peripheral blood eosinophil count over 200 cells/µL or 2% of the total leukocyte count at admission. Those patients, all of whom were treated with oral corticosteroids, had significantly shorter mean length of stay than those below the eosinophil cutoff: 5.0 days (range, 1 to 19 days) versus 6.5 days (range, 1 to 33 days). This finding was independent of treatment prior to admission. Readmission rates were similar between those with high and low eosinophils. Eosinophilic exacerbations were usually not associated with elevated C-reactive protein.

Patients with eosinophilic exacerbations are clinically indistinguishable from other COPD exacerbation patients, the study authors noted. However, this study's results suggest that they may respond rapidly to corticosteroid treatment. This information could reduce treatment failure rates in COPD exacerbations and help identify patients who would most benefit from treatment with corticosteroids or antibiotics, the authors said.

They cautioned that the study was limited by being a subgroup analysis of a larger trial that was not powered to investigate recovery and outcomes from eosinophilic exacerbations. Therefore, the results should be confirmed in a prospective clinical trial that controls for corticosteroid prescription and predefined discharge criteria, the authors said.