What question did this study set out to answer?

To assess how admission blood eosinophil count influences in-hospital mortality among patients with COPD-bronchiectasis overlap treated with systemic corticosteroids.

May 4, 2026Open Access

Association between blood eosinophil count and in-hospital mortality among systemic corticosteroids-treated patients with COPD-bronchiectasis overlap: a retrospective cohort study

Puntos clave

To assess how admission blood eosinophil count influences in-hospital mortality among patients with COPD-bronchiectasis overlap treated with systemic corticosteroids.
Single-center retrospective cohort study of hospitalized AECOPD patients from 2011 to 2020 with bronchiectasis.
Patients were stratified based on their admission blood eosinophil count and analyzed using multivariable logistic regression and propensity score matching.
A total of 9,699 AECOPD patients were included, with 1,421 (14.65%) having bronchiectasis.
In patients with blood eosinophil count <300 cells/μL, systemic corticosteroid use increased in-hospital mortality (adjusted OR 2.05, P = 0.038).
The very low blood eosinophil subgroup (<100 cells/μL) showed even higher mortality risk with systemic corticosteroids (adjusted OR 8.68, P = 0.015).
No increased mortality was associated with systemic corticosteroids in patients with higher blood eosinophil counts (≥300 cells/μL).

Resumen

Background Systemic corticosteroids (SCS) are commonly used for acute exacerbation of COPD (AECOPD), but their effect in patients with COPD-bronchiectasis overlap remains unclear. Whether admission blood eosinophil count (BEC) modifies clinical outcomes in this population is not well-defined. Methods This single-center retrospective cohort study included hospitalized AECOPD patients with radiologically confirmed bronchiectasis (2011–2020). Patients were stratified based on admission BEC. The independent associations of BEC with in-hospital mortality and other outcomes in SCS-treated COPD-bronchiectasis overlap patients were rigorously assessed using multivariable logistic regression and propensity score matching analyses. Results Among 9,699 AECOPD patients, 1,421 (14.65%) had bronchiectasis. SCS use was more common in patients with greater disease severity and lower baseline BEC. In the overall overlap cohort, SCS was not independently associated with mortality after adjustment. However, BEC significantly modified this relationship. In patients with BEC 300 cells/μL, SCS use was associated with increased in-hospital mortality (adjusted OR 2.05, P = 0.038), with the highest risk observed in the very low BEC subgroup (100 cells/μL) (adjusted OR 8.68, P = 0.015), particularly among the elderly (≥70 years) and those with severe radiological bronchiectasis. Conversely, for patients with high BEC level (≥300 cells/μL), SCS use was not linked to increased mortality and was associated with reduced antibiotic treatment. Conclusion In this study, BEC appeared to modify the association between SCS and clinical outcomes in hospitalized COPD-bronchiectasis overlap patients. Observationally, SCS was associated with increased mortality in patients with low BEC, especially among the elderly and those with severe bronchiectasis, whereas no such risk was observed in patients with high BEC. These findings are hypothesis-generating and highlight the potential of BEC to inform personalized treatment strategies. However, they require rigorous prospective validation in randomized controlled trials before any clinical implementation can be considered.

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