Abstract
BackgroundWe investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP).MethodsWe retrospectively reviewed the medical records of patients with AEP treated at the Armed Forces Capital Hospital between May 2012 and May 2017. We used correlation analyses to assess the association between PEC/BEP and clinical outcomes in AEP patients. Receiver operating characteristic (ROC) curve analyses were used to calculate the cut-off value for BEP that categorised patients requiring a significant oxygen supply. The BAL/blood eosinophil (BBE) score was introduced to stratify patients with peripheral eosinophilia and elevated BEP. Clinical characteristics and outcomes were compared between the different groups. Multiple logistic regression was performed for significant oxygen requirements using two different models using age, C-reactive protein (CRP), smoking duration, and BBE score (model 1) and age, CRP, BEP, and PEC (model 2).ResultsAmong the 338 patients, 99.7% were male, and their mean age was 20.4 ± 1.4 years. Only 0.6% of patients were never smokers and the mean number of smoking days was 26.2 ± 25.4. Correlation analyses revealed that both the PaO2/FiO2 ratio and duration of oxygen supply were associated with BEP. ROC curve analyses indicated a cut-off level of 41.5%. Patients with a high BBE score had favourable outcomes in terms of hypoxemia, hospital days, intensive care unit admission, oxygen supply days, and steroid treatment days. Multiple logistic regression revealed that BEP and BBE score tended to be associated with significant oxygen requirements.ConclusionsIn this study, we revealed that both peripheral and BAL eosinophilia is associated with favourable outcomes in AEP patients.
Highlights
We investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP)
Diagnoses were made according to previously proposed criteria as follows: acute-onset febrile respiratory manifestations < 1 month in duration, bilateral diffuse infiltrates observed in chest radiographs, > 25% eosinophils in BAL fluid or eosinophilic pneumonia according to a lung biopsy, and absence of a known cause of pulmonary eosinophilia, including infections, toxins, and drugs [5]
About 37% of patients were initially admitted to the intensive care unit (ICU), and mean hospital days, ICU admission days, and oxygen supply days were 10.5, 2.0, and 2.8, respectively
Summary
We investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP). In previous studies from our centre, the Army Forces Capital Hospital (AFCH), a military hospital in Korea in which more than 70 patients with AEP are diagnosed annually [8,9,10], an association between elevated peripheral eosinophil count (PEC) and milder disease severity in AEP was demonstrated [11, 12]. Separate associations between peripheral blood eosinophil counts (PECs) and BEPs and AEP severity have been demonstrated in previous studies, a combination of these two markers may have superior predictive value for clinical outcomes for such patients
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