哮喘患者嗜酸性粒细胞增多症对严重COVID-19疾病有保护作用
2021/02/09
摘要
背景：目前关于新冠肺炎(COVID-19)在哮喘中转归的相关信息缺乏。
目的：确定感染COVID-19的哮喘患者入院及随后死亡相关的危险因素。
方法：回顾性分析我院2020年3月14日至4月27日之间新冠肺炎检测呈阳性的成人。记录合并症、实验室检查结果和住院期间的死亡率。
结果：总共观察到951例COVID-19哮喘患者中的737例（77.5％）在急诊科（ED）就诊，其中78.8％的哮喘患者（581/737）入院治疗。先前测量平均绝对嗜酸性粒细胞计数≥150cells/μL的患者入院的可能性较小(优势比[OR]=0.46，95%可信区间[CI]：0.21-0.98，P=0.04)，而合并心力衰竭（CHF），慢性肾脏病（CKD）和慢性阻塞性肺疾病（COPD）是入院的危险因素。与AEC<150 cells/μL（n = 213）的患者相比，AEC峰值≥150细胞/μL（n = 104）的住院哮喘患者死亡的可能性较小（死亡率为9.6％vs25.8％；OR = 0.006，95％CI：0.0001-0.64，P =0 .03）。该组的入院前平均AEC也较高（237±181 vs 163±147cells/μL，P =0 .001，OR = 2012，95％CI：27.3-14,816）。单纯哮喘患者（无相关CHF、CKD、COPD、糖尿病或高血压）的死亡率与无哮喘或上述任何合并症的患者的死亡率相似。
结论：在哮喘患者中，预先存在的嗜酸性粒细胞增多症（AEC≥150 cells/μL）可以防止新冠肺炎相关的入院，且住院期间嗜酸性粒细胞增多症（AEC≥150 cells/μL）与死亡率降低相关。入院前AEC影响住院期间AEC趋势。具有Th2型哮喘表型可能是降低新冠肺炎发病率和死亡率的重要预测指标，应在前瞻性和机制研究中进一步探讨。
Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness
Denisa Ferastraoaru, Golda Hudes, Elina Jerschow, Sunit Jariwala, Merhunisa Karagic, Gabriele de Vos, David Rosenstreich, Manish Ramesh
Abstract
BACKGROUND:There is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics.
Objective:To identify risk factors associated with admission and subsequent mortality among COVID-19-infected asthmatics.
Methods:Adults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded.
Results:In total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained <150 cells/μL (n = 213) (mortality rate 9.6% vs 25.8%; OR = 0.006, 95% CI: 0.0001-0.64, P = .03). This group had also higher preadmission mean AEC (237 ± 181 vs 163 ± 147 cells/μL, P = .001, OR = 2012, 95% CI: 27.3-14,816). The mortality rate in patients with asthma alone (no associated CHF, CKD, COPD, diabetes, or hypertension) was similar to that of patients without asthma or any of these comorbidities.
Conclusions:In asthmatics, pre-existing eosinophilia (AEC ≥150 cells/μL) was protective from COVID-19-associated admission, and development of eosinophilia (AEC ≥150 cells/μL) during hospitalization was associated with decreased mortality. Preadmission AEC influenced the AEC trend during hospitalization. Having a Th2-asthma phenotype might be an important predictor for reduced COVID-19 morbidity and mortality that should be further explored in prospective and mechanistic studies.
背景：目前关于新冠肺炎(COVID-19)在哮喘中转归的相关信息缺乏。
目的：确定感染COVID-19的哮喘患者入院及随后死亡相关的危险因素。
方法：回顾性分析我院2020年3月14日至4月27日之间新冠肺炎检测呈阳性的成人。记录合并症、实验室检查结果和住院期间的死亡率。
结果：总共观察到951例COVID-19哮喘患者中的737例（77.5％）在急诊科（ED）就诊，其中78.8％的哮喘患者（581/737）入院治疗。先前测量平均绝对嗜酸性粒细胞计数≥150cells/μL的患者入院的可能性较小(优势比[OR]=0.46，95%可信区间[CI]：0.21-0.98，P=0.04)，而合并心力衰竭（CHF），慢性肾脏病（CKD）和慢性阻塞性肺疾病（COPD）是入院的危险因素。与AEC<150 cells/μL（n = 213）的患者相比，AEC峰值≥150细胞/μL（n = 104）的住院哮喘患者死亡的可能性较小（死亡率为9.6％vs25.8％；OR = 0.006，95％CI：0.0001-0.64，P =0 .03）。该组的入院前平均AEC也较高（237±181 vs 163±147cells/μL，P =0 .001，OR = 2012，95％CI：27.3-14,816）。单纯哮喘患者（无相关CHF、CKD、COPD、糖尿病或高血压）的死亡率与无哮喘或上述任何合并症的患者的死亡率相似。
结论：在哮喘患者中，预先存在的嗜酸性粒细胞增多症（AEC≥150 cells/μL）可以防止新冠肺炎相关的入院，且住院期间嗜酸性粒细胞增多症（AEC≥150 cells/μL）与死亡率降低相关。入院前AEC影响住院期间AEC趋势。具有Th2型哮喘表型可能是降低新冠肺炎发病率和死亡率的重要预测指标，应在前瞻性和机制研究中进一步探讨。
(中日友好医院呼吸与危重症医学科 王静茹 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2021 Jan 22;S2213-2198(20)31409-4. doi: 10.1016/j.jaip.2020.12.045.)
(J Allergy Clin Immunol Pract. 2021 Jan 22;S2213-2198(20)31409-4. doi: 10.1016/j.jaip.2020.12.045.)
Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness
Denisa Ferastraoaru, Golda Hudes, Elina Jerschow, Sunit Jariwala, Merhunisa Karagic, Gabriele de Vos, David Rosenstreich, Manish Ramesh
Abstract
BACKGROUND:There is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics.
Objective:To identify risk factors associated with admission and subsequent mortality among COVID-19-infected asthmatics.
Methods:Adults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded.
Results:In total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained <150 cells/μL (n = 213) (mortality rate 9.6% vs 25.8%; OR = 0.006, 95% CI: 0.0001-0.64, P = .03). This group had also higher preadmission mean AEC (237 ± 181 vs 163 ± 147 cells/μL, P = .001, OR = 2012, 95% CI: 27.3-14,816). The mortality rate in patients with asthma alone (no associated CHF, CKD, COPD, diabetes, or hypertension) was similar to that of patients without asthma or any of these comorbidities.
Conclusions:In asthmatics, pre-existing eosinophilia (AEC ≥150 cells/μL) was protective from COVID-19-associated admission, and development of eosinophilia (AEC ≥150 cells/μL) during hospitalization was associated with decreased mortality. Preadmission AEC influenced the AEC trend during hospitalization. Having a Th2-asthma phenotype might be an important predictor for reduced COVID-19 morbidity and mortality that should be further explored in prospective and mechanistic studies.
上一篇：
自噬诱导小鼠哮喘模型中嗜酸性粒细胞细胞外陷阱形成和过敏性气道炎症
下一篇：
一项产前维生素D平喘试验的六年随访
