The impact of systemic corticosteroids guided by blood eosinophil thresholds and rome classification on clinical outcomes in hospitalized AECOPD patients: a multicenter study
Year: 2026
Type: article
Study design: Observational Study
Abstract: This study assessed the efficacy of combining blood eosinophil (EOS) thresholds and Rome classification to guide corticosteroid therapy in hospitalized acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients. This multicenter study analyzed data from 7 to 111 AECOPD patients, stratified by EOS counts (< 100, 100–300, > 300 cells/μL) and Rome classification severity. Propensity score matching (PSM) was used to balance baseline characteristics between corticosteroid-treated and non-corticosteroid groups. Primary outcomes included 30-day in-hospital mortality, while secondary outcomes encompassed ICU admission, and mechanical ventilation use. Corticosteroid therapy did not significantly reduce short-term mortality but increased the need for non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) in patients with low EOS counts (< 100 cells/μL, 100–300cells/μL) and mild to moderate disease severity (P < 0.05). Patients with higher EOS counts (> 300 cells/μL) and severe disease showed no significant differences in clinical outcomes (P > 0.05). The corticosteroid-treated group exhibited higher rates of hypertension (35.6% vs. 33.0%; P = 0.04), respiratory failure (49.0% vs. 44.6%; P = 0.001) and cor pulmonale (29.0% vs. 24.1%; P < 0.001) but lower rates of osteoporosis (2.1% vs. 3.1%; P = 0.015) and venous thromboembolism (VTE) (4.8% vs. 6.0%; P = 0.041). This multicenter study reveals that systemic corticosteroid therapy does not significantly reduce 30-day in-hospital mortality among AECOPD patients but was associated with increased use of NIV and IMV, particularly in those with EOS counts < 300 cells/μL and mild to moderate disease severity. Future research should focus on identifying subgroups benefiting from corticosteroids and exploring alternative treatments for others at risk. Trial registration : Chinese clinical trial registry, ChiCTR2100044625. URL: http://www.chictr.org.cn/showproj.aspx?proj=121626 ; date of Registration: 24 Mar 2021.
Institutions: Sichuan University, West China Hospital of Sichuan University, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Sir Run Run Shaw Hospital, Zhejiang University, Tongji Hospital, Huazhong University of Science and Technology, The First People's Hospital of Neijiang, Central South University, Xiangya Hospital Central South University, Jiujiang First People's Hospital, Chengdu University, University of Electronic Science and Technology of China, Sichuan Cancer Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
OpenAlex ID: W7160767360