{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:18:25Z","timestamp":1787807905694,"version":"build-2784847793"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Blood eosinophil (EOS) guides corticosteroid therapy in stable chronic obstructive pulmonary disease (COPD), but its prognostic value in COPD exacerbation (ECOPD) remains controversial. This study characterized clinical features and assessed the impact of EOS levels on clinical outcomes in hospitalized ECOPD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed hospitalized patients with ECOPD between 2018 and 2023. Patients were categorized according to percentage of peripheral blood eosinophil: the eosinophilic group (EOS\u202f\u2265\u202f2%) and the non-EOS group (EOS\u202f&amp;lt;\u202f2%). The primary outcome was in-hospital mortality, while the secondary outcomes included ICU admission, mechanical ventilation, and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 511 patients (EOS group,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f139; non-EOS group,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f372), the EOS group had lower levels of inflammatory markers (C-reactive protein and procalcitonin) and a lower detection rate of Gram-negative bacilli, especially\n                      <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                      . The EOS group exhibited significantly lower rates of ICU admission (25.18% vs. 50.27%;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and in-hospital mortality (1.44% vs. 6.72%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.018). In the multivariable analyses, EOS%\u202f\u2265\u202f2% remained associated with lower odds of in-hospital mortality after adjustment for age and heart failure (adjusted OR, 0.225; 95% CI, 0.052\u20130.971;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.046) and with lower odds of ICU admission after adjustment for age, sex, and heart failure (adjusted OR, 0.357; 95% CI, 0.229\u20130.556;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among hospitalized patients with ECOPD, elevated peripheral blood eosinophils were associated with favorable clinical outcomes, especially a reduced risk of ICU admission, as well as a lower systemic inflammation burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1917271","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:27:24Z","timestamp":1787804844000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic inflammation, microbiology, and clinical outcomes in eosinophilic and non-eosinophilic acute exacerbations of chronic obstructive pulmonary disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Ning","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Peking University Third Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiqiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Peking University Third Hospital","place":["Beijing, China"]},{"name":"Research Center for Chronic Airway Diseases, Peking University Health Science Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujie","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Lulong County Hospital","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Information Management and Big Data Center, Peking University Third Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Peking University Third Hospital","place":["Beijing, China"]},{"name":"Research Center for Chronic Airway Diseases, Peking University Health Science Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Peking University Third Hospital","place":["Beijing, China"]},{"name":"Research Center for Chronic Airway Diseases, Peking University Health Science Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongchang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Peking University Third Hospital","place":["Beijing, China"]},{"name":"Research Center for Chronic Airway Diseases, Peking University Health Science Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/S0140-6736(07)61382-8","article-title":"COPD exacerbations: defining their cause and prevention","volume":"370","author":"Wedzicha","year":"2007","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1016\/j.jaci.2018.04.010","article-title":"Blood eosinophil count thresholds and exacerbations in patients with chronic obstructive pulmonary disease","volume":"141","author":"Yun","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3045","DOI":"10.2147\/COPD.S170743","article-title":"Eosinophil counts in first COPD hospitalizations: a comparison of health service utilization","volume":"13","author":"B\u00e9langer","year":"2018","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1164\/rccm.201708-1684LE","article-title":"Blood eosinophilia neither reflects tissue eosinophils nor worsens clinical outcomes in chronic obstructive pulmonary disease","volume":"197","author":"Turato","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"107501","DOI":"10.1016\/j.rmed.2023.107501","article-title":"The association between blood eosinophils and clinical outcome of acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis","volume":"222","author":"Liu","year":"2024","journal-title":"Respir Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1164\/rccm.202009-3448OC","article-title":"Inflammatory endotype-associated airway microbiome in chronic obstructive pulmonary disease clinical stability and exacerbations: a multicohort longitudinal analysis","volume":"203","author":"Wang","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/1059079","article-title":"Clinical differences between eosinophilic and noneosinophilic acute exacerbation of chronic obstructive pulmonary disease: a multicenter cross-sectional study","volume":"2020","author":"Dai","year":"2020","journal-title":"Mediat Inflamm"},{"key":"ref8","year":"2025"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1164\/rccm.201108-1553OC","article-title":"Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial","volume":"186","author":"Bafadhel","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.chest.2016.01.026","article-title":"Blood eosinophils and outcomes in severe 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disease","volume":"10","author":"Wang","year":"2023","journal-title":"Front Mol Biosci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3000605241299943","DOI":"10.1177\/03000605241299943","article-title":"Impact of blood eosinophil count on clinical outcomes in hospitalized Syrian patients with COPD exacerbation","volume":"52","author":"Albuaini","year":"2024","journal-title":"J Int Med Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3233","DOI":"10.2147\/JIR.S421605","article-title":"The prognostic value of blood eosinophil level in AECOPD is influenced by corticosteroid treatment during hospitalization","volume":"16","author":"Li","year":"2023","journal-title":"J Inflamm Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e90638","DOI":"10.7759\/cureus.90638","article-title":"Peripheral blood eosinophil as a predictor of clinical outcomes in acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study from a tertiary Care Center in South India","volume":"17","author":"Mounika","year":"2025","journal-title":"Cureus"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2023\/8678702","article-title":"Association of Upon-Diagnosis Blood Eosinophilic Count with frequency and severity of annual exacerbation in chronic obstructive pulmonary disease: a prospective longitudinal analysis","volume":"2023","author":"Kiani","year":"2023","journal-title":"Can Respir J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"169","DOI":"10.2147\/COPD.S396311","article-title":"Blood eosinophils and clinical outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: a prospective cohort study","volume":"18","author":"Pu","year":"2023","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"281","DOI":"10.2147\/COPD.S289920","article-title":"Association between blood eosinophils and mortality in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study","volume":"16","author":"Yang","year":"2021","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.hrtlng.2022.05.012","article-title":"Clinical features and three-year prognosis of AECOPD patients with different levels of blood eosinophils","volume":"56","author":"Ruiying","year":"2022","journal-title":"Heart Lung"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.2147\/COPD.S88058","article-title":"Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?","volume":"10","author":"Salt\u00fcrk","year":"2015","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"442","DOI":"10.4103\/lungindia.lungindia_49_24","article-title":"Prognostic significance of eosinophil-to-platelet ratio and C-reactive protein in predicting adverse events during acute exacerbations of chronic obstructive pulmonary disease: a comprehensive observational study","volume":"41","author":"Yogesh","year":"2024","journal-title":"Lung India"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1757274","DOI":"10.1080\/20018525.2020.1757274","article-title":"Elevated blood eosinophils in acute COPD exacerbations: better short- and long-term prognosis","volume":"7","author":"Jabarkhil","year":"2020","journal-title":"Eur Clin Respir J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1525709","DOI":"10.3389\/fmed.2025.1525709","article-title":"Association between eosinophil count and prognosis in chronic obstructive pulmonary disease patients","volume":"12","author":"Hsu","year":"2025","journal-title":"Front Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3298","DOI":"10.4081\/monaldi.2025.3298","article-title":"Prognostic role of blood eosinophils in acute exacerbations of chronic obstructive pulmonary disease: systematic review and meta-analysis","volume":"96","author":"Para","year":"2025","journal-title":"Monaldi Arch Chest Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"953","DOI":"10.2147\/copd.s197361","article-title":"The association between blood eosinophil percent and bacterial infection in acute exacerbation of chronic obstructive pulmonary disease","volume":"14","author":"Choi","year":"2019","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/CM9.0000000000001690","article-title":"Association between blood eosinophil count and bacterial infection and clinical outcomes in patients with severe exacerbations of chronic obstructive pulmonary disease","volume":"135","author":"Wang","year":"2021","journal-title":"Chin Med J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1183\/13993003.01406-2015","article-title":"Lung microbiome dynamics in COPD exacerbations","volume":"47","author":"Wang","year":"2016","journal-title":"Eur Respir J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jaci.2020.02.040","article-title":"The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease","volume":"147","author":"Dicker","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12890-021-01443-4","article-title":"The association between eosinophilic exacerbation and eosinophilic levels in stable COPD","volume":"21","author":"Kang","year":"2021","journal-title":"BMC Pulm Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e0302318","DOI":"10.1371\/journal.pone.0302318","article-title":"High blood eosinophils predict the risk of COPD exacerbation: a systematic review and meta-analysis","volume":"19","author":"Chen","year":"2024","journal-title":"PLoS One"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/s12890-020-01234-3","article-title":"The stability of blood eosinophils in stable chronic obstructive pulmonary disease: a retrospective study in Belgian primary care","volume":"20","author":"Van Rossem","year":"2020","journal-title":"BMC Pulm Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e000151","DOI":"10.1136\/bmjresp-2016-000151","article-title":"Effect of inhaled corticosteroids on blood eosinophil count in steroid-na\u00efve patients with COPD","volume":"3","author":"Kreindler","year":"2016","journal-title":"BMJ Open Respir Res"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1917271\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:27:24Z","timestamp":1787804844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1917271\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":33,"alternative-id":["10.3389\/fmed.2026.1917271"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1917271","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"1917271"}}