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Background <p>Blood eosinophils are recommended by GOLD as a biomarker for inhaled corticosteroid (ICS) therapy in COPD, yet their stability during acute exacerbations of COPD (AECOPD) remains uncertain.</p> Methods <p>We retrospectively analyzed 3,311 hospitalized AECOPD patients (2018–2023). Blood eosinophil distribution, longitudinal trends, and within-patient variability were assessed. Linear mixed-effects models estimated overall trajectories of ln(1 + EOS) over standardized hospital days (SHD). Variability was quantified by coefficient of variation (CV%), within-patient SD (wSD), and median absolute change between consecutive tests. Robustness of thresholds (100 and 300 cells/µL) was examined by crossing and reclassification rates, with simulations of 20–30% overall decline. Near-threshold “decision bands” were derived from the empirical median change (≈ 50 cells/µL).</p> Results <p>Blood eosinophils showed a right-skewed distribution with a median of 100 cells/µL (IQR 20–200). Mixed-effects models indicated only a mild overall increase (+ 2.16% per + 1 SD in SHD). In patients with repeated tests (<i>n</i> = 1,548), within-patient variability was substantial (median CV% 76.6%; wSD 57 cells/µL; median |Δ| 50 cells/µL). Threshold crossing and first–last reclassification were frequent (≥ 100: 45.7% and 32.9%; ≥300: 22.7% and 16.0%), and declined only slightly in simulated steroid-reduction scenarios. Approximately 13% of patients fluctuated between &lt; 100 and ≥ 300 cells/µL during one admission.</p> Conclusion <p>EOS should be interpreted dynamically, with retesting or trend assessment recommended to guide clinical decisions during acute exacerbations.</p>

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Stability of blood eosinophils during acute exacerbations in patients with chronic obstructive pulmonary disease

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  • 发表日期：

    2025年12月18日

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  • Qidong Chen,
  • Wei Ji,
  • Hongyu Wang,
  • Jiahui Lin,
  • Tanwei Liu,
  • Jialin Lin,
  • Xu Chen,
  • Xiaoyang Chen

摘要

Background

Blood eosinophils are recommended by GOLD as a biomarker for inhaled corticosteroid (ICS) therapy in COPD, yet their stability during acute exacerbations of COPD (AECOPD) remains uncertain.

Methods

We retrospectively analyzed 3,311 hospitalized AECOPD patients (2018–2023). Blood eosinophil distribution, longitudinal trends, and within-patient variability were assessed. Linear mixed-effects models estimated overall trajectories of ln(1 + EOS) over standardized hospital days (SHD). Variability was quantified by coefficient of variation (CV%), within-patient SD (wSD), and median absolute change between consecutive tests. Robustness of thresholds (100 and 300 cells/µL) was examined by crossing and reclassification rates, with simulations of 20–30% overall decline. Near-threshold “decision bands” were derived from the empirical median change (≈ 50 cells/µL).

Results

Blood eosinophils showed a right-skewed distribution with a median of 100 cells/µL (IQR 20–200). Mixed-effects models indicated only a mild overall increase (+ 2.16% per + 1 SD in SHD). In patients with repeated tests (n = 1,548), within-patient variability was substantial (median CV% 76.6%; wSD 57 cells/µL; median |Δ| 50 cells/µL). Threshold crossing and first–last reclassification were frequent (≥ 100: 45.7% and 32.9%; ≥300: 22.7% and 16.0%), and declined only slightly in simulated steroid-reduction scenarios. Approximately 13% of patients fluctuated between < 100 and ≥ 300 cells/µL during one admission.

Conclusion

EOS should be interpreted dynamically, with retesting or trend assessment recommended to guide clinical decisions during acute exacerbations.