The Prognostic Value of Blood Eosinophil Level in AECOPD is Influenced by Corticosteroid Treatment During Hospitalization

Li, Jiachen; Liang, Lirong; Feng, Lin; Cao, Siyu; Cai, Yutong Samuel; Li, Xiaobo; Qian, Zhenbei; Brightling, Christopher E; Tong, Zhaohui

doi:10.2147/jir.s421605

Cited by 8 publications

(3 citation statements)

References 43 publications

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“…[36][37][38] Others regard eosinophilic AECOPD as an inflammatory phenotype, which demonstrates a favorable response to corticosteroid treatment. 10,13,14,[39][40][41] Our results align with this perspective. Factors bolstering our conclusion include the exclusion of those with pneumonia, pulmonary infection or systemic fungal infection at presentation and by controlling for age, comorbidities, and severity markers during statistical analysis.…”

Section: Discussionsupporting

confidence: 89%

Comprehensive Nomograms Using Routine Biomarkers Beyond Eosinophil Levels: Enhancing Predictability of Corticosteroid Treatment Outcomes in AECOPD

Feng,

Li,

Qian

et al. 2024

JIR

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Purpose Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) exhibit heterogeneous responses to corticosteroid treatment. We aimed to determine whether combining eosinophil levels with other routine clinical indicators can enhance the predictability of corticosteroid treatment outcomes and to come up with a scoring system. Patients and Methods Consecutive patients admitted with AECOPD receiving corticosteroid treatment between July 2013 and March 2022 at Beijing Chao-Yang Hospital were retrospectively analyzed. Data on patients’ demographics, smoking status, hospitalization for AECOPD in the previous year, comorbidities, blood laboratory tests, in-hospital treatment and clinical outcomes were collected. Least absolute shrinkage and selection operator (LASSO) regression and backward logistic regression were used for predictor selection, and predictive nomograms were developed. The discrimination and calibration of the nomograms were assessed using the area under the receiver operating curve (AUC) and calibration plots. Internal validation was performed using the 500-bootstrap method, and clinical utility was evaluated using decision curve analysis (DCA). Results Among the 3254 patients included, 804 (24.7%) had treatment failure. A nomogram of eosinophils, platelets, C-reactive protein (CRP), low density lipoprotein cholesterol, prognostic nutritional index (PNI), hospitalization for AECOPD in the previous year, ischemic heart diseases and chronic hepatic disease was developed to predict treatment failure for patients with a smoking history. For patients without a smoking history, a nomogram of CRP, PNI, ischemic heart diseases and chronic hepatic disease was developed. Although the AUCs of these two nomograms were only 0.644 and 0.647 respectively, they were significantly superior to predictions based solely on blood eosinophil levels. Conclusion We developed easy-to-use comprehensive nomograms utilizing readily available clinical biomarkers related to inflammation, nutrition and immunity, offering modestly enhanced predictive value for treatment outcomes in corticosteroid-treated patients with AECOPD. Further investigations into novel biomarkers and additional patient data are imperative to optimize the predictive performance.

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Section: Discussionsupporting

confidence: 89%

Comprehensive Nomograms Using Routine Biomarkers Beyond Eosinophil Levels: Enhancing Predictability of Corticosteroid Treatment Outcomes in AECOPD

Feng,

Li,

Qian

et al. 2024

JIR

Self Cite

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“…Additionally, we were hesitant to give much weight to the cohort studies during our interpretation of the results due to their small size and inherent risk of bias [43]. The low number of studies also meant we were unable to perform subgroup analysis, so the effects of prognostic factors such as blood eosinophil count and age were unable to be assessed [44]. As FEV 1 /FVC and % predicted FEV 1 tends to misdiagnose very young and old patients, this may have impacted the results of the studies used in this review [12,14].…”

Section: Limitations Of Our Studymentioning

confidence: 99%

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

Zhao,

Lou,

Wang

et al. 2023

PLoS ONE

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While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40–1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81–-0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90–1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60–1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59–1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80–75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines. Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.

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“…Additionally, we were hesitant to give much weight to the cohort studies during our interpretation of the results due to their small size and inherent risk of bias [35]. The low number of studies also meant we were unable to perform subgroup analysis, so the effects of prognostic factors such as blood eosinophil count were unable to be assessed [36]. There was heterogeneity in the specifics of the corticosteroid regimens used in each study in terms of corticosteroid type, administration methods, treatment duration/dosage, and the presence of a taper.…”

Section: Limitations Of Our Studymentioning

confidence: 99%

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

Zhao,

Lou,

Wang

et al. 2023

Preprint

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While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short-(≤7 day) and long- (>7 day) corticosteroid regimens in adults with acute exacerbations of COPD.MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eight eligible RCTs and three retrospective cohort studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as odds ratios (ORs) or mean differences (MDs) whenever possible and qualitatively described otherwise.A total of 11532 participants were included, with 1296 eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR for mortality was 0.76 (95% CI=0.40–1.44, n=1055). The MD for hospital length-of-stay was -0.91 days (95% CI=-1.81–-0.02 days, n=421). The OR for re-exacerbations was 1.31 (95% CI=0.90–1.90, n=552). The OR for hyperglycemia was 0.90 (95% CI=0.60–1.33, n=423). The OR for infection incidence was 0.96 (95% CI=0.59–1.156, n=389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI=-111.80–75.01 mL, n=161).The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines for corticosteroid administration.No funding was given for this review. Our protocol is registered in PROSPERO: CRD42023374410.

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The Prognostic Value of Blood Eosinophil Level in AECOPD is Influenced by Corticosteroid Treatment During Hospitalization

Cited by 8 publications

References 43 publications

Comprehensive Nomograms Using Routine Biomarkers Beyond Eosinophil Levels: Enhancing Predictability of Corticosteroid Treatment Outcomes in AECOPD

Comprehensive Nomograms Using Routine Biomarkers Beyond Eosinophil Levels: Enhancing Predictability of Corticosteroid Treatment Outcomes in AECOPD

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

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