T2 Biomarkers as Predictors of Exacerbations of Chronic Obstructive Pulmonary Disease

• Bernardino Alcázar-Navarrete ^[3] ; Jose Manuel Díaz-Lopez ^[3] ; Paula García-Flores ^[3] ; Marina Ortega-Antelo ^[3] ; Ivan Aguilar-Cruz ^[4] ; Oliverio Ruiz-Rodríguez ^[1] ; Pablo Santiago-Diaz ^[1] ; Pedro José Romero Palacios ^[2]
  1. [1] Hospital de Poniente

     Hospital de Poniente

     Almería, España

     
  2. [2] Universidad de Granada

     Universidad de Granada

     Granada, España

     
  3. [3] Respiratory Department, HU Virgen de las Nieves, Granada, Spain
  4. [4] Emergency Department, Hospital Clínico San Cecilio, Granada, Spain

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 58, Nº. 8, 2022, págs. 595-600
• Idioma: inglés
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• Resumen

  • Introduction Type 2 (T2) biomarkers such as blood eosinophil count (BEC) and FeNO have been related to a higher risk of exacerbations in COPD. It is unknown whether combining these biomarkers could be useful in forecasting COPD exacerbations.

    Methods COPD patients were enrolled in this prospective, multicenter, observational study and followed up for 1 year, during which BEC were analysed at baseline (V0) while FeNO analyses were performed at baseline (V0), 6 months (V1) and 12 months (V2). The risk of moderate or severe exacerbation during follow up was assessed by Cox regression analysis, and the predictive capacity of both measurements was assessed by ROC curves and the DeLong test. Statistical significance was assumed at P < .05.

    Results Of the 322 COPD patients initially recruited, 287 were followed up. At baseline, 28.0% were active smokers, and experienced moderate airflow limitation (mean FEV1 56.4% ± 17.0% predicted). Patients with at least one elevated T2 biomarker (n = 125, 42.5%) were at increased risk of COPD exacerbation (HR 1.75, 95% CI 1.25–2.45, P = .001) and of shorter time to first COPD exacerbation. There was no difference between BEC and FeNO regarding the predictive capacity for moderate to severe exacerbation (AUC 0.584 vs 0.576, P = .183) but FeNO predicted severe episodes more accurately than BEC (AUC 0.607 vs 0.539, P < .05). Combining the two biomarkers enhanced the detection of moderate and severe COPD exacerbations.

    Conclusions Both eosinophil count and FeNO have limited utility for predicting COPD exacerbations. Combining these T2 biomarkers could enhance the detection of future COPD exacerbations.