Analysis on clinical features and prognosis of the acute exacerbation of chronic obstructive pulmonary disease patients with different inflammatory phenotypes

ZHU Yajing; LIU Juan; QIN Yan; WANG Lijun

doi:10.3969/j.issn.1674-3806.2024.03.09

Abstract：Objective To analyze the clinical features and prognosis of the acute exacerbation of chronic obstruc-tive pulmonary disease(AECOPD)patients with different inflammatory phenotypes.Methods The clinical data of 255 patients with AECOPD who were admitted to the Department of Respiratory Medicine of Northern Jiangsu People's Hos-pital from January 2021 to April 2022 were retrospectively analyzed.The patients were divided into eosinophil(EOS)group(87 cases),neutrophil group(92 cases),mixed granulocyte group(30 cases)and agranulocytosis group(46 cases)according to their initial peripheral blood cell count results at admission.The clinical features and the readmission rates of the patients admitted to hospital for AECOPD within one year after discharge were compared among the four groups.Results There were statistically significant differences in white blood cell count(WBC),EOS percentage(EOS%),EOS,neutrophil(NE)percentage(NE%),NE,lymphocyte(LY)percentage(LY%),LY,neutrophil count to lymphocyte count ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT)and albumin(ALB)levels among the patients in the four groups(P＜0.05).The neutrophil group had higher WBC,NE%,NE,NLR,CRP and PCT levels,and lower EOS%,EOS,LY%,LY and ALB levels compared with the EOS group.The mixed granulocyte group had higher WBC,NE%,NE and NLR levels,and lower LY%,LY and ALB levels than the EOS group,and the mixed granulocyte group had higher EOS%and EOS levels than the neutrophil group.Compared with the neutrophil group and the mixed gran-ulocyte group,the agranulocytosis group had lower WBC,NE%,NE,NLR and PCT levels,and higher LY%and LY levels.EOS%and EOS levels in the agranulocytosis group were lower than those in the EOS group and the mixed granu-locyte group,while CRP level in the agranulocytosis group was lower than that in the neutrophil group.The differences were statistically significant(P＜0.05).There were statistically significant differences in the pulmonary function indexes a-mong the patients in the four groups(P＜0.05).The neutrophil group had lower forced expiratory volume in one second as a percentage of the predicted value(FEV1%pred)and forced expiratory volume in one second(FEV1)/forced vital capacity(FVC)levels than the EOS group.FEV1%pred and FEV1/FVC levels in the agranulocytosis group were higher than those in the neutrophil group,while FEV1/FVC level in the agranulocytosis group was higher than that in the mixed granulocyte group.The differences were statistically significant(P＜0.05).There were statistically significant differ-ences in the hospitalized days,utilization rates of intravenous corticosteroids and antibiotics among the patients in the four groups(P＜0.05).The neutrophil group had more hospitalized days and higher utilization rate of intravenous corti-costeroids than the EOS group,and the neutrophil group had higher utilization rate of antibiotics than the EOS group and the agranulocytosis group.The differences were statistically significant(P＜0.05).Kaplan-Meier survival curves showed that the readmission rates of the patients admitted to hospital for AECOPD were ranked from high to low in the neutrophil group(61.06%),the mixed granulocyte group(54.78%),the agranulocytosis group(45.23%)and the EOS group(42.89%),and the log-rank test showed statistically significant differences among the 4 groups(χ2=10.816,P=0.013).Conclusion There are significant differences in inflammatory indicators,nutritional status,pulmonary function,hospitalized days,therapeutic effect and prognosis among the AECOPD patients with four different inflammatory phenotypes based on peripheral blood cell count.The AECOPD patients with neutrophilic type show more severe clinical features and have a higher rate of readmission to hospital for AECOPD within one year after discharge than those with eosinophilic type.