Blood Eosinophil Count In Patients Research Articles

Relationship between triglyceride-glucose index and blood eosinophils among asthmatic individuals in the USA

BackgroundPresently, the majority of investigations primarily evaluate the correlation between triglyceride-glucose index (TyGI) with lung diseases, such as asthma. However, they did not delve into the correlation between TyGI and inflammatory responses related to the disease. Few studies have explored the association between TyGI and blood eosinophil count (BEOC). Thus, National Health and Nutrition Examination Survey (NHANES) data were used in this study to evaluate the correlation between TyGI and BEOC in individuals with asthma.MethodsThis study investigated 3902 individuals with asthma. Linear regression analysis was performed to investigate the association between TyGI and BEOC in patients with asthma. Subsequently, the GAM and threshold effect models were used to validate the presence of either a nonlinear or linear association between TyGI and BEOC. Finally, stratified analyses were conducted to ascertain the correlations between different subgroups.ResultsFour linear regression models confirmed a positive linear correlation between TyGI and BEOC in patients with asthma. In Model D, which controlled for all covariates, BEOC increased by 12.44 cells/uL for every extra unit of TyGI. The GAM and threshold effect models further verified the positive linear correlation between TyGI and BEOC. The XGBoost model indicated that the six most significant variables influencing BEOC, in order of relative importance, were age, cholesterol level, body mass index (BMI), poverty-to-income ratio (PIR), BNEUC, and TyGI.ConclusionsIn patients with asthma, the study discovered a linear positive correlation between TyGI and BEOC. This indicates a potential connection between TyGI and alterations in the immune status of individuals with asthma, which may help detect abnormalities in a timely manner and provide a reference for clinical decision-making. This study offers fresh insights for the future exploration of the management and treatment of asthma.

Use of CompEx in eosinophilic patients with severe, uncontrolled asthma on benralizumab.

CompEx Asthma, a composite end-point for asthma exacerbations, captures clinically relevant, diary-based acute worsening events (AWEs) (defined as deterioration in daily peak expiratory flow concurrent with deterioration in asthma symptoms and/or rescue therapy use) and severe exacerbations (SevEx) (defined by American Thoracic Society/European Respiratory Society guidelines). We hypothesised that CompEx and SevEx would show similar benralizumab treatment effects and correlations to blood eosinophil counts in patients with severe asthma. This post hoc analysis of pooled 12-month data from two phase 3 studies included patients aged ≥16 years with severe, uncontrolled asthma who were randomised to benralizumab 30 mg or placebo. Annualised event rates were analysed using a negative binomial model. The impact of blood eosinophil count on treatment effect was assessed. Among patients with a blood eosinophil count ≥300 cells·µL-1 (n=913), benralizumab reduced the annualised event rate versus placebo for CompEx (1.57 versus 2.57; risk ratio 0.61, 95% CI 0.53-0.70, p<0.001), SevEx (0.94 versus 1.55; risk ratio 0.60, 95% CI 0.52-0.70, p<0.001) and AWE (0.92 versus 1.57; risk ratio 0.59, 95% CI 0.48-0.72, p<0.001), with greater treatment effects observed for higher blood eosinophil counts. In patients with blood eosinophil count ≥300 cells·µL-1, benralizumab was associated with shorter median event duration (CompEx: 10.5 days versus 17.0 days; SevEx: 10.0 days versus 15.0 days; AWE: 5.0 days versus 6.0 days). Benralizumab reduced the risk of CompEx events with treatment effects similar to those for SevEx and AWEs across a range of blood eosinophil counts. Use of CompEx supports the evaluation of benralizumab and other novel drugs in clinical studies.

Olfactory cleft mucus eosinophil-derived neurotoxin better reflects olfactory loss than blood eosinophil counts in patients with chronic rhinosinusitis.

Eosinophils are associated with olfactory dysfunction in chronic rhinosinusitis (CRS) and eosinophil-derived neurotoxin (EDN) is a sensitive marker of intense eosinophil activation. This study aimed to analyze olfactory cleft mucus and olfactory mucosa EDN levels and their association with olfactory dysfunction in CRS. We prospectively recruited 150 patients with CRS electing endoscopic sinus surgery and 25 healthy controls. Both superior turbinate biopsy specimens and olfactory cleft mucus were collected to analyze EDN levels. Sniffin' Sticks test scores, olfactory cleft computed tomography (CT) scores, and olfactory cleft endoscopy scale (OCES) were obtained. Multivariable logistic regression analysis was applied to analyze the predictability of EDN levels for olfactory dysfunction in CRS. Chronic rhinosinusitis with olfactory dysfunction presented significantly higher olfactory mucosa (p=0.016) and olfactory cleft mucus (p<0.001) EDN levels than CRS without olfactory dysfunction. Mucus EDN levels were positively correlated with blood eosinophils (r=0.625, p=0.002), olfactory cleft CT scores (r=0.738, p<0.001), and OCES (r=0.605, p=0.004) in CRS. Furthermore, mucus EDN levels were significantly negatively correlated with threshold, discrimination, and identification (TDI) (r=-0.688), olfactory threshold (r=-0.606), olfactory discrimination (r=-0.608), and olfactory identification (r=-0.697) scores. After adjusting for patient demographics and comorbidities, mucus EDN levels were significantly associated with olfactory dysfunction in CRS (odds ratio=2.162; p=0.027). Mucus EDN levels showed a significantly better performance for predicting olfactory dysfunction than blood eosinophil counts (area under the curve, 0.873vs. 0.764, p=0.024). Olfactory cleft mucus EDN level may be a better biomarker for predicting olfactory dysfunction in CRS than blood eosinophil counts.

Clinical Implications of Longitudinal Blood Eosinophil Counts in Patients With Severe Asthma

The stability and variability of blood eosinophil counts (BECs) to phenotype patients with severe asthma is not fully understood. This post hoc, longitudinal, pooled analysis of placebo-arm patients from 2 phase 3 studies evaluated the clinical implications of BEC stability and variability in moderate-to-severe asthma. This analysis included patients from SIROCCO and CALIMA who received maintenance medium- to high-dosage inhaled corticosteroids plus long-acting β2-agonists; 2:1 patients with BECs of 300 cells/μL or higher and less than 300 cells/μL were enrolled. The BECs were measured 6 times over 1 year in a centralized laboratory. Exacerbations, lung function, and Asthma Control Questionnaire 6 scores were documented across patients grouped by BEC (<300 cells/μL or ≥300 cells/μL) and variability (<80% or ≥80% BECs less than or greater than 300 cells/μL). Among 718 patients, 42.2% (n= 303) had predominantly high, 30.9% (n= 222) had predominantly low, and 26.9% (n= 193) had variable BECs. Prospective exacerbation rates (mean ± SD) were significantly greater in patients with predominantly high (1.39 ± 2.20) and variable (1.41 ± 2.09) BECs versus predominantly low (1.05 ± 1.66) BECs. Similar results were observed for the number of exacerbations while on placebo. Although patients with variable BECs had intermittently high and low BECs, they experienced similar exacerbation rates to the predominantly high group, which were greater than those in the predominantly low group. A high BEC supports an eosinophilic phenotype in clinical settings without additional measurements, whereas a low BEC requires repeated measurements because it could reflect intermittently high or predominantly low BECs.

Relationship Between Blood Eosinophils and Systemic Corticosteroid Therapy in COPD Exacerbation.

PurposeTo assess the relationship between the duration of systemic corticosteroid therapy and blood eosinophil counts in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).Patients and MethodsThis study included 292 patients with acute COPD exacerbations treated with daily intravenous injections of 40 mg/day methylprednisolone at the Department of Respiratory Medicine, Anhui No.2 Provincial People’s Hospital, Hefei, China. The study subjects were divided into two groups – (1) a low-dose group (n = 136) that included patients treated with methylprednisolone for less than or equal to 5 days and (2) a high-dose group (n = 156) that included patients treated with methylprednisolone for more than 5 days. The blood eosinophil counts were analyzed for both the patient groups, and an optimal cut-off value was calculated to distinguish between the two groups. The study endpoints were readmission or deaths within 30 days or 180 days and re-infections within 90 days after hospital discharge.ResultsThe mean blood eosinophil counts in the low- and high-dose groups were 0.15 × 109/L (0.11–0.23 × 109/L) and 0.08 × 109/L (0.04–0.12 × 109/L), respectively (P < 0.01). Receiver operating characteristic (ROC) curve analysis showed that the cut-off value for the blood eosinophils to distinguish the two patient groups was 0.115 × 109/L with a sensitivity and specificity of 72.8% and 72.4%, respectively. The number of readmissions between the two groups at 30 days and 180 days after hospital discharge did not show any significant differences (P = 0.292, P = 0.398). The follow-up data showed significantly higher rate of re-infections in the high-dose group (24/136) within 90 days after hospital discharge compared to the low-dose group (9/156) (P = 0.018).ConclusionIn patients with acute exacerbations of COPD, blood eosinophil counts of ≥0.115 × 109/L were associated with effective response to corticosteroid therapy in ≤5 days.

The Effectiveness of Budesonide Nasal Irrigation in Patients with Allergic Rhinitis.

BackgroundAllergic rhinitis (AR) is a long-standing disease and has been shown to cause significant impairment in patients’ quality of life. Saline nasal irrigation is a proven adjunct in the treatment of AR. The addition of steroid to the saline solution can provide local steroid effect and increase the effectiveness of this technique. Our study aimed to determine the effectiveness of budesonide nasal irrigation as an adjunct to the treatment of AR, compared with saline nasal irrigation.MethodsThis was a randomised controlled study involving 99 patients diagnosed with AR, half of whom were treated with saline nasal irrigation and the other half with budesonide nasal irrigation. Parameters measured include the Sino-Nasal Outcome Test (SNOT-22) questionnaire, endoscopic nasal examination findings and blood eosinophil count.ResultsPatients treated with budesonide nasal irrigation had significant improvement in total SNOT-22 score (P < 0.001) and improvement in the endoscopic nasal examination findings, such as nasal mucosa oedema and secretions (P < 0.001). However, there was no significant improvement of blood eosinophil count in patients treated with either budesonide or saline nasal irrigation.ConclusionBudesonide nasal irrigation is effective as an adjunct in the treatment of AR.

Effect of atorvastatin on serum periostin and blood eosinophils in asthma - a placebo-controlled randomized clinical trial.

ObjectiveTo investigate the effect of atorvastatin on serum periostin level and blood eosinophil count in patients with asthma.MethodsPatients diagnosed with asthma were enrolled and randomised into an intervention or placebo group, to receive 40 mg atorvastatin or similar placebo, daily, for 8 weeks. Spirometry was performed at baseline, and at the end of weeks 4 and 8; patients also provided blood samples and completed an asthma control test (ACT) at baseline and at the end of week 8. Primary study outcomes were blood eosinophil count and serum periostin levels.ResultsEighty patients completed the study (40 per group). Mean ACT scores were similar between the intervention and placebo groups at baseline (17.95 ± 3.75 versus 17.98 ± 3.77, respectively), and improved in the intervention group (19.88 ± 3.28), but remained unchanged in the placebo group (18.6 ± 3.26) during the treatment period. No statistically significant differences in spirometric changes, blood eosinophil count or serum periostin levels were observed between the groups during the treatment period.ConclusionSpirometric parameters and inflammatory markers did not change significantly in response to atorvastatin treatment, and did not differ between the placebo and intervention groups.

Low Peripheral Blood Eosinophil Counts in Patients with Acute Graft-Versus-Host-Disease Prior to Systemic Corticosteroid Therapy Is Associated with Poor Prognosis

Background: Acute graft-versus-host-disease (aGVHD) is one of the main complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT), occurring in about half of patients. Patients with grade II-IV aGVHD require treatment with systemic corticosteroids. However, 30% of them show steroid resistance, leading to poor prognosis. Thus, pretreatment prediction of steroid refractoriness allows for early secondary treatment introduction, which may improve aGVHD outcomes. The possible association between elevated peripheral blood (PB) eosinophil counts and the development of aGVHD has been previously reported. In contrast, several studies showed an association with better outcomes after allo-HSCT. These reports imply that PB eosinophil counts may predict prognosis in patients with aGVHD. In this study, we investigated the predictive role of pretreatment PB eosinophil counts in patients with aGVHD treated with systemic corticosteroid therapy.Methods: Retrospective case analysis was performed on 121 patients with hematological malignancies who underwent allo-HSCT between October 2010 and January 2017 in our institutes and developed any grade of aGVHD. We excluded patients who did not require systemic corticosteroid therapy (n=53), and who developed aGVHD after premature discontinuation of calcineurin inhibitors (n=5) because of relapse or calcineurin toxicities. Finally, a total of 63 patients were enrolled. PB smears obtained within 2 days before the start of systemic corticosteroid therapy were microscopically examined. The cut-off value of eosinophil counts for predicting survival was determined using receiver operating characteristic (ROC) curve analysis. The primary endpoint was 1-year overall survival (OS), measured from the start of systemic corticosteroid therapy to death due to any cause or the last follow-up. The secondary endpoints were 1-year progression-free survival (PFS), 1-year cumulative incidence (CI) of non-relapse mortality (NRM), and CI of relapse. OS and PFS were compared using the log-rank test and CIs of NRM and relapse were compared using Gray's test. Predictors of OS were evaluated using univariate and multivariate analysis using Cox's proportional hazards model.Results: The median age was 48 years (range: 40-59 years), and 31 patients (60.8%) were male. Primary diagnoses were acute myeloid leukemia (n=21), acute lymphoblastic leukemia (n=18), myelodysplastic syndrome (n=9), malignant lymphoma (n=13), multiple myeloma (n=1), and chronic myelomonocytic leukemia (n=1). They received bone marrow (n=38), peripheral blood stem cells (n=5), and cord blood (n=20). The median PB eosinophil count was 96/mm3 (range: 0-2903/mm3). ROC analysis revealed the cut-off value for predicting 1-year OS as 133/mm3 (area under the curve: 0.783; 95% confidence interval, 0.662-0.904). Thus, we defined patients with eosinophil counts ≥133/mm3 as the “high eosinophil group” (n=30) and the others as the “low eosinophil group” (n=33). There was no difference in clinical characteristics between the two groups, with the exception of days from transplantation to systemic corticosteroid therapy (29 days in the low eosinophil group vs. 43 days in the high eosinophil group, p<0.001). Regarding the primary endpoint, the 1-year OS rates were 65.2% and 93.3% in the low and high eosinophil groups, respectively (p=0.008) (Figure A). In the univariate analysis, the hazard ratio (HR) for 1-year OS of the low eosinophil group was 6.0 (95% confidence interval: 1.3-27.2, p=0.020). In the multivariate analysis adjusted for eosinophil counts (low vs. high), recipient age (≥50 vs. <50 years), aGVHD grade (III-IV vs. I-II), and stem cell source, the low eosinophil group showed independent poor prognosis for 1-year OS (HR, 6.0; 95% confidence interval, 1.3-28.4; p=0.023). Especially in patients with grade III-IV aGVHD, the low eosinophil group showed substantially inferior 1-year OS rates than those in the high eosinophil group (35.0% vs. 88.9%, p=0.032) (Figure B). Regarding secondary endpoints, 1-year PFS rates were 59.2% and 89.9% (p=0.006), 1-year CI rates of NRM were 21.7% and 3.33% (p=0.035), and 1-year CI rates of relapse were 19.1% and 6.8% (p=0.145) in the low and high eosinophil groups, respectively (Figures C-E).Conclusion: Low PB eosinophil counts before systemic corticosteroid therapy is associated with inferior 1-year OS after aGVHD due to elevated NRM. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Blood eosinophil count in patients with COPD on inhaled corticosteroids in comparison with healthy smoker and nonsmoker controls

Background Chronic obstructive pulmonary disease (COPD) is associated with acute and chronic pulmonary inflammation in the lung and as a systemic inflammation. The blood eosinophil counts are now recommended by the Global Initiative for the Management of Obstructive Lung Disease as a guide of inhaled corticosteroid use in clinical practice, as it can predict its effect on the rate of COPD exacerbation. The increasing peripheral blood eosinophilic count in patients with COPD could explain the systemic eosinophilia in COPD, which causes increased lung eosinophil count in these patients, especially those on inhaled corticosteroids (ICS). Patients and methods The study included 56 patients with COPD who were active smokers with pack-years beyond 10 as cases. The control group includes 60 patients as healthy nonsmokers (HNS) and 66 patients as healthy current smokers (HS), with pack-year beyond 10. Prebronchodilator and postbronchodilator spirometry was done in the pulmonary function unit of the Chest Department, Ain Shams University Hospital, to confirm or to exclude the COPD diagnosis. The COPD cases were categorized as per the Global Initiative for the Management of Obstructive Lung Disease severity assessment guideline and were receiving budesonide 800 μg/day and formoterol 24 μg/day or salmeterol 100 μg and fluticasone propionate 500 μg twice daily. Skin prick test and complete blood count for its differential and eosinophil count were done for all cases. Results The study included 56 patients with COPD who were active smokers and received ICS. The control group included 60 patients as HNS along with 66 patients as healthy current smokers. The HNS group showed the least total leukocytic count of 5588.33±1081.13/µl and the least eosinophilic count of 99.47±91.51/µl, whereas the COPD group showed the highest total leukocytic count. A statistically significant relation was found also between COPD patients’ eosinophil count and the use of ICS, with P value 0.000. Conclusion The peripheral blood eosinophil counts collected from patients with COPD on ICS are significantly higher than the patients with COPD who are not using ICS and the healthy smoker and nonsmoker control group.

Frequency of Raised Total Serum Ig E, Sputum Eosinophilia and Blood Eosinophil Count in Patients with Severe Persistent Asthma

Introduction: Asthma is a chronic inflammatory airway disorder that has several inflammatory phenotypes. Serum immunoglobulin E (IgE) and eosinophils are airway inflammation markers in asthmatic patients. In this research, we assessed the asthma severity with various inflammatory markers.&#x0D; Aims &amp; Objectives: To find the frequency of raised total serum immunoglobulin E, sputum eosinophilia, and absolute blood eosinophil count in patients with severe persistent asthma.&#x0D; Place and duration of study: This study was conducted in Department of Pulmonology, Shaikh Zayed FPGMI, Lahore from 1st October 2018 to 1st April 2019.&#x0D; Material &amp; Methods: A Cross-sectional study in which total of 125 patients were enrolled after fulfilling the inclusion criteria. Blood samples were taken with aseptic measures for total serum immunoglobulin E and absolute blood eosinophils count. Sputum was collected in the sterile jar and dispensed properly to the histopathology lab.&#x0D; Results: Of 125 patients, 44.8% were males, and 55.2% were females. The mean patient's age was 49.37 years, and the mean duration of symptoms was 25.49 years. Raised serum immunoglobulin E levels were seen in 74.4% patients, sputum eosinophilia was seen in 25.6% patients, and increased peripheral eosinophil count was seen in 55.2%. Age was significantly associated with sputum eosinophilia; however, no such association was seen between the other effect modifiers and inflammatory markers.&#x0D; Conclusion: Inflammatory markers immunoglobulin E, sputum and blood eosinophil levels were significantly raised in asthma patients. These can be used in the detection of asthma as their detection is easy, simple, and non-invasive, and they are directly linked to the inflammation.

COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice.

Background Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists. Methods A questionnaire evaluating doctors’ opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures. Results Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor’s questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients’ medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %. Conclusions In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians’ increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.

Eosinophils Protect Mice From Angiotensin-II Perfusion-Induced Abdominal Aortic Aneurysm.

Blood eosinophil count and ECP (eosinophil cationic protein) associate with human cardiovascular diseases. Yet, whether eosinophils play a role in cardiovascular disease remains untested. The current study detected eosinophil accumulation in human and murine abdominal aortic aneurysm (AAA) lesions, suggesting eosinophil participation in this aortic disease. To test whether and how eosinophils affect AAA growth. Population-based randomized clinically controlled screening trials revealed higher blood eosinophil count in 579 male patients with AAA than in 5063 non-AAA control (0.236±0.182 versus 0.211±0.154, 109/L, P<0.001). Univariate (odds ratio, 1.381, P<0.001) and multivariate (odds ratio, 1.237, P=0.031) logistic regression analyses indicated that increased blood eosinophil count in patients with AAA served as an independent risk factor of human AAA. Immunostaining and immunoblot analyses detected eosinophil accumulation and eosinophil cationic protein expression in human and murine AAA lesions. Results showed that eosinophil deficiency exacerbated AAA growth with increased lesion inflammatory cell contents, matrix-degrading protease activity, angiogenesis, cell proliferation and apoptosis, and smooth muscle cell loss using angiotensin-II perfusion-induced AAA in Apoe-/- and eosinophil-deficient Apoe-/-ΔdblGATA mice. Eosinophil deficiency increased lesion chemokine expression, muted lesion expression of IL (interleukin) 4 and eosinophil-associated-ribonuclease-1 (mEar1 [mouse EOS-associated-ribonuclease-1], human ECP homolog), and slanted M1 macrophage polarization. In cultured macrophages and monocytes, eosinophil-derived IL4 and mEar1 polarized M2 macrophages, suppressed CD11b+Ly6Chi monocytes, and increased CD11b+Ly6Clo monocytes. mEar1 treatment or adoptive transfer of eosinophil from wild-type and Il13-/- mice, but not eosinophil from Il4-/- mice, blocked AAA growth in Apoe-/-ΔdblGATA mice. Immunofluorescent staining and immunoblot analyses demonstrated a role for eosinophil IL4 and mEar1 in blocking NF-κB (nuclear factor-κB) activation in macrophages, smooth muscle cells, and endothelial cells. Eosinophils play a protective role in AAA by releasing IL4 and cationic proteins such as mEar1 to regulate macrophage and monocyte polarization and to block NF-κB activation in aortic inflammatory and vascular cells.

Variability in Blood Eosinophil Counts in Patients with Eosinophilic Asthma

Blood eosinophil (EOS) counts are critical to the accurate identification of asthma phenotypes. However, there are few long-term data on intraindividual EOS count variability among patients with eosinophilic asthma. This post hoc analysis of 2 phase III clinical trials from the reslizumab BREATH program explored the variability of blood EOS counts in patients with eosinophilic asthma receiving placebo. Pooled data from study participants receiving placebo (previously randomized 1:1 to receive reslizumab or placebo) were analyzed for blood EOS count variability over 52 weeks. EOS counts were measured up to twice during screening, every 4 weeks from randomization to the end of treatment and at the 90-day follow-up visit. Of 476 included patients, 31 (6.5%), 38 (8.0%), 55 (11.6%), and 352 (73.9%) patients had baseline blood EOS counts of <150, ≥150 to <300, ≥300 to <400, and ≥400 cells/μL, respectively. Patients frequently shifted between EOS count categories during the 52-week treatment period, most often moving to the highest EOS category. Among patients in each of the lower 3 EOS categories, 27% to 56% of patients shifted to the ≥400 cells/μL category at some point during the treatment period. Intraindividual variability in blood EOS count was high among patients with eosinophilic asthma receiving placebo, with shifts to ≥400 cells/μL from lower categories frequently observed. Repeat determinations of blood EOS count may be important to ensure appropriate selection of therapy in patients with severe asthma.

Prognostic Role of Blood Eosinophil Count in Patients with Sorafenib-Treated Hepatocellular Carcinoma.

Inflammation is a long-established hallmark of liver fibrosis and carcinogenesis. Eosinophils are emerging as crucial components of the inflammatory process influencing cancer development. The role of blood eosinophils in patients with hepatocellular carcinoma receiving systemic treatment is an unexplored field. The objective of this study was to analyse the prognostic role of the baseline eosinophil count in patients with sorafenib-treated hepatocellular carcinoma. A training cohort of 92 patients with advanced- or intermediate-stage sorafenib-treated hepatocellular carcinoma and two validation cohorts of 65 and 180 patients were analysed. Overall survival and progression-free survival in relation to baseline eosinophil counts were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed. A negative prognostic impact of low baseline eosinophil counts (< 50*109/L) was demonstrated in all cohorts (training cohort: hazard ratio = 50.1, 95% confidence interval 11.6-216.5, p < 0.0001 for low vs high eosinophil counts; first validation cohort: hazard ratio = 4.55, 95% confidence interval 1.24-16.65, p = 0.022; second validation cohort: hazard ratio = 3.21, 95% confidence interval 1.83-5.64, p < 0.0001). Moreover, low eosinophil counts had a negative prognostic role in patients progressing on or intolerant to sorafenib who received second-line regorafenib, but not capecitabine or best supportive care. Our analysis identified baseline blood eosinophil counts as a new prognostic factor in patients with sorafenib-treated hepatocellular carcinoma. Concerning second-line therapies, eosinophil counts were associated with survival outcomes only in regorafenib-treated patients, suggesting a possible predictive role in this setting.

The effect of medical treatment on nasal exhaled nitric oxide (NO) in patients with persistent allergic rhinitis: A randomized control study

PurposeThis study aimed to evaluate the role of nasal nitric oxide (NO) in the management of patients with persistent allergic rhinitis (PER). MethodsIt was a randomized and comparative study. The study subjects were classified as controls (healthy subjects) or patients with PER based on defined criteria. All clinical, functional and biological data were collected for analyzing. Nasal fractional exhaled nitric oxide (FENO) was measured by electroluminescence device. Patients with PER were randomized for treatment with antihistamine (ATH) combined with leukotriene receptor antagonists (LRA) or only with intranasal steroids (INS). ResultsDuring two years, 501 subjects were included: 234 control subjects and 267 patients with PER. The levels of nasal NO, total IgE, blood eosinophil counts, and apnea-hypopnea index (AHI) in patients with PER were higher than controls (P < 0.001; P < 0.05; P < 0.05; P < 0.01; respectively). There were statistically significant correlations between nasal NO, nasal peak flows, total IgE, and blood eosinophil counts in patients with PER (R = −0.687 and P = 0.0012; R = −0.643 and P = 0.0018; R = 0.432 and P = 0.0024; R = 0.445 and P = 0.002; respectively). After 6 months of treatment, patients treated with INS had greater improvement of clinical symptoms and reduction of nasal NO values than patients treated with ATH + LRA (985 ± 253 vs. 732 ± 298 ppb; P < 0.05). ConclusionNasal NO measurement is a useful tool for the follow-up of patients with PER. It also helps clinicians to estimate the level of response to treatment in patients with PER.

Study of the role of blood eosinophil count in patients with severe acute exacerbation of chronic obstructive pulmonary disease hospitalized in a Tunisian Center

IntroductionIl existe une controverse concernant la relation entre le taux d'éosinophiles sanguins (Eos) et la sévérité des exacerbations de BPCO. L'objectif de notre travail est de déterminer la relation entre le taux d'Eos et les différents paramètres de sévérité d'une exacerbation aiguë (EA) sévère de BPCO.MéthodesÉtude rétrospective monocentrique portant sur les patients porteurs de BPCO suivis entre 2005 et 2015 ayant nécessité l'hospitalisation. Nous avons comparé 2 groupes de patients: G1(Eos+): Eos ≥ 200 cell/μl (103 cas, 20,4%), G2(Eos-): Eos < 200 cell/μl (403 patients: 79,6%).RésultatsCinq cent six patients BPCO ont été inclus dans l'étude. Il n'y avait pas de différence significative entre les 2 groupes concernant l'âge, le genre, le VEMS, et le nombre d'EA/an (Eos+:2.6, Eos-:2.5 EA/an; p = 0,48). L'analyse des paramètres de sévérité des EA sévères montre l'absence de différence entre les 2 groupes concernant la PaO2 mesurée à l'admission (60,5, 59,2 mmHg; p = 0,26), la capnie (p = 0,57), le pH (p = 0,74), le taux de CRP (mg/l) (82,7, 81; p = 0,89), la leucocytose (p = 0,36), le recours à la ventilation non invasive (5.8%, 6.5%; p = 0,81), la ventilation mécanique invasive (p = 0,5), la durée d'hospitalisation (9.7, 9 jours; p = 0,21), ainsi que le délai de la prochaine EABPCO (p = 0,32). La survie à 1 an était comparable entre les 2 groupes (94% vs 96%; Log Rank: 0,708).ConclusionI'augmentation du taux d'Eos chez les patients BPCO ne semble pas avoir une influence péjorative au cours des EA sévères. Malgré la prise en considération du taux d'Eos dans les décisions thérapeutiques dans les récentes recommandations, l'importance et l'intérêt pronostique de l'Eos au cours de la BPCO pourrait être population dépendant.

Relationship between Blood and Induced Sputum Eosinophils, Bronchial Hyperresponsiveness and Reversibility of Airway Obstruction in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Blood eosinophilia has been proposed as a surrogate marker for airway eosinophilia and as a predictor of treatment response in chronic obstructive pulmonary disease (COPD). The aim of the study was to assess the relationship between blood and sputum eosinophils and to investigate the association between blood and sputum eosinophil count and clinical features of mild-to-moderate COPD. We performed a retrospective analysis of blood and sputum eosinophil count, as well as demographic and lung function data in a cohort of 90 stable, steroid-naive (Global Initiative for Chronic Obstructive Lung Disease 1 or 2) COPD patients and 20 control subjects. Blood and sputum eosinophil count did not correlate both in patients with COPD (r = –0.04 p = 0.705) and in controls (r = 0.05, p = 0.838). Sputum eosinophilia (≥3%) was present in 40% of COPD patients. The median blood eosinophil count in patients with COPD was 180 (interquartile range 90–270)/μL; patients with low blood eosinophils (<180/μL) did not differ from those with high blood eosinophils (≥180/μL) in terms of forced expiratory volume in 1 second, bronchial reversibility or hyperresponsiveness. This was also the case when COPD patients with and without sputum eosinophilia were compared. At the same time, positive bronchial reversibility and positive bronchial hyperresponsiveness were observed in 2 (11%) COPD patients with high blood eosinophils and in 1 (5%) patient with sputum eosinophilia. There was a weak, albeit significant correlation (r = 0.22 p = 0.041) between blood eosinophil count and age in patients with COPD. Peripheral eosinophil count poorly reflects sputum eosinophils and lung function in stable steroid-naive mild-to-moderate COPD patients.

Association of plasma fibrinogen concentrations and blood eosinophil counts with clinical phenotypes of COPD.

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), the plasma fibrinogen level is associated with a decline in lung function and exacerbation of COPD. High blood eosinophil count is also associated with exacerbation of COPD in some studies but not others.OBJECTIVE: To investigate the associations between clinical phenotypes and plasma fibrinogen levels and blood eosinophil counts in patients with COPD.METHODS: Outpatients with COPD, in whom plasma fibrinogen level and blood eosinophil count were measured at least once simultaneously, were analysed retrospectively. Patients were classified into four groups, based on plasma fibrinogen level (threshold, 350 mg/dl) and blood eosinophil percentage (threshold, 2%). Clinical characteristics, comorbidities, laboratory data, COPD severity and exacerbations were compared in the four groups.RESULTS: Of 370 patients with COPD, the group with both high fibrinogen levels and eosinophil counts had more severe airflow limitation, more comorbidities and higher COPD severity indexes than the groups with low plasma fibrinogen. The annual rates of severe (0.29/year) and total (0.42/year) exacerbations were significantly higher in patients with both high fibrinogen and eosinophils than in the other three groups.CONCLUSION: Plasma fibrinogen levels and blood eosinophil counts may predict the clinical phenotype and frequency of exacerbations of COPD.

Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial

Previous studies have highlighted a relationship between reduction in rate of exacerbations with therapies containing inhaled corticosteroids (ICS) and baseline blood eosinophil count in patients with chronic obstructive pulmonary disease (COPD). The IMPACT trial showed that once-daily single-inhaler triple therapy significantly reduced exacerbations versus dual therapies. Blood eosinophil counts and smoking status could be important modifiers of treatment response to ICS. We aimed to model these relationships and their interactions, including outcomes other than exacerbations. IMPACT was a phase 3, randomised, double-blind, parallel-group, 52-week global study comparing once-daily single-inhaler triple therapy (fluticasone furoate-umeclidinium-vilanterol) with dual inhaled therapy (fluticasone furoate-vilanterol or umeclidinium-vilanterol). Eligible patients had moderate-to-very-severe COPD and at least one moderate or severe exacerbation in the previous year. We used fractional polynomials to model continuous blood eosinophil counts. We used negative binomial regression for numbers of moderate and severe exacerbations, severe exacerbations, and pneumonia. We modelled differences at week 52 in trough FEV1, St George's Respiratory Questionnaire (SGRQ) total score, and Transition Dyspnoea Index using repeated measurements mixed effect models. IMPACT was registered with ClinicalTrials.gov, number NCT02164513. The magnitude of benefit of regimens containing ICS (fluticasone furoate-umeclidinium-vilanterol n=4151 and fluticasone furoate-vilanterol n=4134) in reducing rates of moderate and severe exacerbations increased in proportion with blood eosinophil count, compared with a non-ICS dual long-acting bronchodilator (umeclidinium-vilanterol n=2070). The moderate and severe exacerbation rate ratio for triple therapy versus umeclidinium-vilanterol was 0·88 (95% CI 0·74 to 1·04) at blood eosinophil count less than 90 cells per μL and 0·56 (0·47 to 0·66) at counts of 310 cells per μL or more; the corresponding rate ratio for fluticasone furoate-vilanterol versus umeclidinium-vilanterol was 1·09 (0·91 to 1·29) and 0·56 (0·47 to 0·66), respectively. Similar results were observed for FEV1, Transition Dyspnoea Index, and SGRQ total score; however, the relationship with FEV1 was less marked. At blood eosinophil counts less than 90 cells per μL and at counts of 310 cells per μL or more, the triple therapy versus umeclidinium-vilanterol treatment difference was 40 mL (95% CI 10 to 70) and 60 mL (20 to 100) for trough FEV1, -0·01 (-0·68 to 0·66) and 0·30 (-0·37 to 0·97) for Transition Dyspnoea Index score, and -0·01 (-1·81 to 1·78) and -2·78 (-4·64 to -0·92) for SGRQ total score, respectively. Smoking status modified the relationship between observed efficacy and blood eosinophil count for moderate or severe exacerbations, Transition Dyspnoea Index, and FEV1, with former smokers being more corticosteroid responsive at any eosinophil count than current smokers. This analysis of the IMPACT trial shows that assessment of blood eosinophil count and smoking status has the potential to optimise ICS use in clinical practice in patients with COPD and a history of exacerbations. GlaxoSmithKline.

PERIPHERAL BLOOD EOSINOPHIL SHIFTS IN SEVERE, UNCONTROLLED ASTHMA

Introduction Greater clarity is needed on peripheral blood eosinophil counts (BEC) associated with events such as exacerbations or responsiveness to biologics in severe asthma. Inclusion criteria and prespecified analyses on peripheral BECs vary between clinical trials. Stability of BEC on repeated measures in this population is unknown. We examined shifts in BEC in patients with severe, uncontrolled asthma despite high-dosage inhaled corticosteroids/long-acting β2-agonists. Methods BEC shift was examined in patients randomized to placebo in two Phase III studies, SIROCCO (NCT01928771; 48 weeks) and CALIMA (NCT01914757; 56 weeks). We grouped patients by baseline BEC and counted the number in each baseline group who had ≥1 recorded peripheral BEC and who then shifted BEC group during the trial. Results 141 patients receiving placebo had a baseline peripheral BEC <150 cells/μL. Of these, 70.2% (n=99) had ≥1 BEC ≥150 cells/μL and 34.8% (n=49) had a BEC ≥300 cells/μL. An additional 170 patients had a baseline peripheral BEC 150≤300 cells/μL. Of these, 62.4% (n=106) had ≥1 BEC ≥300 cells/μL. 428 patients had a baseline peripheral BEC ≥300 cells/μL. Of these, 52.8% (n=226) had ≥1 BEC <300 cells/μL, and 22.4% (n=96) had a BEC <150 cells/μL (figure). Conclusions Most patients with a baseline BEC <150 cells/µL during SIROCCO or CALIMA, and approximately one-third had at least one BEC measurement ≥300 cells/µL. The data suggest that a single BEC does not negate the possibility of a patient having eosinophil-driven disease. Performing additional BECs may be of benefit. Percentage of Patients with Shifts in Peripheral Blood Eosinophil Count Group After Baseline Greater clarity is needed on peripheral blood eosinophil counts (BEC) associated with events such as exacerbations or responsiveness to biologics in severe asthma. Inclusion criteria and prespecified analyses on peripheral BECs vary between clinical trials. Stability of BEC on repeated measures in this population is unknown. We examined shifts in BEC in patients with severe, uncontrolled asthma despite high-dosage inhaled corticosteroids/long-acting β2-agonists. BEC shift was examined in patients randomized to placebo in two Phase III studies, SIROCCO (NCT01928771; 48 weeks) and CALIMA (NCT01914757; 56 weeks). We grouped patients by baseline BEC and counted the number in each baseline group who had ≥1 recorded peripheral BEC and who then shifted BEC group during the trial. 141 patients receiving placebo had a baseline peripheral BEC <150 cells/μL. Of these, 70.2% (n=99) had ≥1 BEC ≥150 cells/μL and 34.8% (n=49) had a BEC ≥300 cells/μL. An additional 170 patients had a baseline peripheral BEC 150≤300 cells/μL. Of these, 62.4% (n=106) had ≥1 BEC ≥300 cells/μL. 428 patients had a baseline peripheral BEC ≥300 cells/μL. Of these, 52.8% (n=226) had ≥1 BEC <300 cells/μL, and 22.4% (n=96) had a BEC <150 cells/μL (figure). Most patients with a baseline BEC <150 cells/µL during SIROCCO or CALIMA, and approximately one-third had at least one BEC measurement ≥300 cells/µL. The data suggest that a single BEC does not negate the possibility of a patient having eosinophil-driven disease. Performing additional BECs may be of benefit.