title: Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?
abstract: BACKGROUND
  COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%-25% of COPD exacerbations are eosinophilic.
  
  
  OBJECTIVE
  To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU.
  
  
  METHODS
  This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects' characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data.
  
  
  RESULTS
  Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2-7 days) vs 6 days (3-9 days) (P<0.002), and 12.9% vs 24.9% (P<0.034), respectively.
  
  
  CONCLUSIONS
  COPD exacerbations with acute respiratory failure requiring ICU admission had a better outcome with a peripheral eosinophil level >2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management.
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Saltürk
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Karakurt
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Adiguzel
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Feyza
authors.initials: F
authors.lastname: Kargin
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Rabia
authors.initials: R
authors.lastname: Sari
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: M Emin
authors.initials: ME
authors.lastname: Celik
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Huriye Berk
authors.initials: HB
authors.lastname: Takir
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Tuncay
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Sogukpinar
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Nezihe
authors.initials: N
authors.lastname: Ciftaslan
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Mocin
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Gokay
authors.initials: G
authors.lastname: Gungor
authors.affiliation: Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey.
authors.forename: Selahattin
authors.initials: S
authors.lastname: Oztas
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D018450:Disease Progression; D004802:Eosinophilia / Q000097:blood*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications*; D012131:Respiratory Insufficiency / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D002097:C-Reactive Protein
keywords: chronic obstructive pulmonary disease; exacerbation; intensive care unit; peripheral eosinophilia; respiratory failure