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Clinical features, bacteriology of endotracheal aspirates and treatment outcomes of patients with chronic obstructive pulmonary disease and community-acquired pneumonia in an intensive care unit in Taiwan with an emphasis on eosinophilia versus non-eosinophilia: a retrospective case–control study
  1. Wei-Chang Huang1,2,3,
  2. Ching-Hsiao Lee3,
  3. Ming-Feng Wu2,4,
  4. Chen-Cheng Huang5,
  5. Cheng-Hui Hsu2,
  6. Hui-Chen Chen2,
  7. Jeng-Yuan Hsu6,7,8,
  8. Chieh-Chen Huang1
  1. 1 Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
  2. 2 Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  3. 3 Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
  4. 4 Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
  5. 5 Division of Chest Medicine, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
  6. 6 Division of Clinical Research, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  7. 7 School of Medicine, China Medical University, Taichung, Taiwan
  8. 8 School of Physical Therapy, Chung-Shan Medical University, Taichung, Taiwan
  1. Correspondence to Professor Chieh-Chen Huang; cchuang{at}nchu.edu.tw

Abstract

Objectives The clinical implications of blood eosinophil level in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission are still unknown. Thus, this study aimed to compare the features of such patients with and without blood eosinophilia.

Design This was a retrospective case–control study.

Setting An ICU of a medical centre in central Taiwan.

Participants A total of 262 patients with COPD and CAP requiring IMV and ICU admission.

Results Of all participants (n=262), 32 (12.2%) had an eosinophil percentage (EP) >2% and 169 (64.5%) had an absolute eosinophil count (AEC) >300 cells/µL. Regardless of whether 2% or 300 cells/µL was used as a cut-off value, the eosinophilia group were slightly older (years) (82.9±5.4 vs 78.1±9.1, p=0.000 and 79.2±8.4 vs 77.6±9.6, p=0.246, respectively), and had a higher forced expiratory volume in 1 s/forced vital capacity (%) (56.0±8.0 vs 51.3±11.6, p=0.005 and 53.1±11.2 vs 49.5±11.2, p=0.013, respectively), less severe spirometric classification (p=0.008 and p=0.001, respectively), and lower white cell count 109/L (8.8±3.2 vs 11.1±4.9, p=0.009 and 10.3±4.4 vs 11.8±5.3, p=0.017, respectively) than the non-eosinophilia group. The bacteriology of endotracheal aspirates showed that Pseudomonas aeruginosa and other gram-negative bacilli were the most common organisms in all study groups. Participants with an EP >2% had a shorter ICU length of stay (OR=12.13, p=0.001) than those with an EP ≤2%, while an AEC >300 cells/µL was not associated with any in-ICUoutcomes.

Conclusions The results of this study have significant clinical implications and should be considered when making treatment decisions for the management of patients with COPD and CAP requiring IMV and ICU admission.

  • blood eosinophil
  • community-acquired pneumonia
  • COPD
  • intensive care unit

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Footnotes

  • J-YH and C-CH contributed equally.

  • Contributors All authors designed and performed the study. W-CH, Che-CH, M-FW, C-HL, C-HH and H-CC collected the data. All authors analysed and interpreted the data. W-CH, J-YH and Chi-CH wrote the paper. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent None required.

  • Ethics approval The Institutional Review Board and Ethics Committee of TCVGH approved this study (approval number: CE17160B).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No available additional unpublished data from the study.

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