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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

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 co...

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Autores principales: Huang, Wei-Chang, Lee, Ching-Hsiao, Wu, Ming-Feng, Huang, Chen-Cheng, Hsu, Cheng-Hui, Chen, Hui-Chen, Hsu, Jeng-Yuan, Huang, Chieh-Chen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144339/
https://www.ncbi.nlm.nih.gov/pubmed/30206074
http://dx.doi.org/10.1136/bmjopen-2017-020341
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author Huang, Wei-Chang
Lee, Ching-Hsiao
Wu, Ming-Feng
Huang, Chen-Cheng
Hsu, Cheng-Hui
Chen, Hui-Chen
Hsu, Jeng-Yuan
Huang, Chieh-Chen
author_facet Huang, Wei-Chang
Lee, Ching-Hsiao
Wu, Ming-Feng
Huang, Chen-Cheng
Hsu, Cheng-Hui
Chen, Hui-Chen
Hsu, Jeng-Yuan
Huang, Chieh-Chen
author_sort Huang, Wei-Chang
collection PubMed
description 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 10(9)/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.
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spelling pubmed-61443392018-09-21 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 Huang, Wei-Chang Lee, Ching-Hsiao Wu, Ming-Feng Huang, Chen-Cheng Hsu, Cheng-Hui Chen, Hui-Chen Hsu, Jeng-Yuan Huang, Chieh-Chen BMJ Open Respiratory Medicine 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 10(9)/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. BMJ Publishing Group 2018-09-11 /pmc/articles/PMC6144339/ /pubmed/30206074 http://dx.doi.org/10.1136/bmjopen-2017-020341 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Respiratory Medicine
Huang, Wei-Chang
Lee, Ching-Hsiao
Wu, Ming-Feng
Huang, Chen-Cheng
Hsu, Cheng-Hui
Chen, Hui-Chen
Hsu, Jeng-Yuan
Huang, Chieh-Chen
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Respiratory Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144339/
https://www.ncbi.nlm.nih.gov/pubmed/30206074
http://dx.doi.org/10.1136/bmjopen-2017-020341
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