目的:研究表明嗜酸性粒细胞增多与慢性阻塞性肺疾病急性加重期(AECOPD)的临床预后相关。然而,矛盾的发现存在。本研究旨在系统评价AECOPD患者外周血嗜酸性粒细胞升高与临床预后的关系。
方法:对从数据库开始到2023年2月28日在PubMed上发表的相关研究进行了电子搜索,EMBASE,科克伦图书馆,和WebofScience。该分析涵盖了EOSAECOPD与死亡率之间的相关性研究,住院时间,再入院率和住院率,有创机械通气。如果适用,提取相对风险(RR)和加权平均差(WMD),池化,并使用荟萃分析进行评估。进行敏感性分析以探索异质性的来源。
结果:15项高质量研究包括14项队列研究和1项病例对照研究纳入荟萃分析。与非嗜酸性粒细胞AECOPD患者比较,嗜酸性粒细胞AECOPD患者的死亡风险较低(RR=0.65,95%置信区间[CI]0.54,0.77,P<0.001),住院时间较短(WMD=-1.56,95CI-2.16,-0.96,P<0.001),再入院率较高(RR=1.07,95CI1.01,1.13,P=0.029)。两组住院率和有创机械通气率无差异。
结论:诊断为嗜酸性粒细胞AECOPD的个体死亡率降低,一段截短的住院时间,并且相对于非嗜酸性粒细胞性AECOPD患者,再入院的可能性没有实质性增加。血液中嗜酸性粒细胞水平已被证明是AECOPD患者的潜在预测生物标志物。
OBJECTIVE: Studies have shown an association between eosinophilia and clinical outcomes in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, contradictory findings exist. Our study aims to systematically evaluate the association between elevated peripheral blood eosinophils and clinical outcome of patients with AECOPD.
METHODS: An electronic search was conducted for relevant studies published from database inception to February 28, 2023, on PubMed, EMBASE, Cochrane Library, and Web of Science. The analysis covered studies on the correlation between EOS AECOPD and mortality, hospital stay duration, readmission and hospitalization rates, and invasive mechanical ventilation. Where applicable, relative risk (RR) and weighted mean difference (WMD) were extracted, pooled, and assessed using meta-analysis. Sensitivity analysis was performed to explore the source of heterogeneity.
RESULTS: Fifteen high-quality studies including 14 cohort studies and one case-control study were included in the meta-analysis. Compared with non-eosinophilic AECOPD patients, those with eosinophilic AECOPD had a lower risk of mortality (RR = 0.65, 95 % confidence interval [CI] 0.54, 0.77, P < 0.001), shorter length of hospital stay (WMD = -1.56, 95%CI -2.16, -0.96, P < 0.001), and higher readmission rate (RR = 1.07, 95%CI 1.01,1.13, P = 0.029). No difference was found concerning the rate of hospitalization and invasive mechanical ventilation between the two groups.
CONCLUSIONS: Individuals diagnosed with eosinophilic AECOPD had a reduced mortality rate, a truncated period of hospitalization, and an insubstantial increase in the probability of readmission relative to their non-eosinophilic AECOPD counterparts. The level of eosinophils in blood has been shown to serve as a potential predictive biomarker for AECOPD patients.