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Publications

Journal Article Multicenter Study Ppublish

PubMed: 41511276 DOI: 10.1080/25310429.2025.2611215

Blood eosinopenia (≤30/µL) as an early predictor of respiratory failure in community-acquired pneumonia: A prospective multicentre study.

Pulmonology 32(1):2611215

Authors: Barbara Christine Weckler, Roman Martin, Max Kutzinski, Wilhelm Bertrams, Anna Lena Jung, Hendrik Pott, Katrin Laakmann, Leon Schulte, Peter Ahnert, Dominik Heider, Stephan Ringshandl, Christian Seidemann, Norbert Suttorp, Martin Witzenrath, Christian Wildberg, Mareike Lehmann, Gernot Rohde, Timm Greulich, Claus Franz Vogelmeier, Bernd Schmeck

Affiliations

  • Department of Respiratory, Intensive Care, and Sleep Medicine, Clinic for Respiratory Infections, Marburg University, Marburg, Germany.
  • Institute for Lung Research, Universities of Giessen and Marburg Lung Center (UGMLC), Marburg University, Marburg, Germany.
  • Institute of Medical Informatics, University of Münster, Münster, Germany.
  • Core Facility Flow Cytometry - Bacterial Vesicles, Marburg University, Marburg, Germany.
  • German Centre for Lung Research (DZL), Marburg, Germany.
  • Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
  • German Center for Lung Research (DZL), Leipzig, Germany.
  • Department of Medicine, Data Integration Centre (DIC), Marburg University, Marburg, Germany.
  • Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • German Center for Lung Research (DZL), Berlin, Germany.
  • CAPNETZ STIFTUNG, Hannover, Germany.
  • Institute for Lung Health (ILH), Giessen, Germany.
  • Institute of Lung Health and Immunity, Comprehensive Pneumology Center Munich, Helmholtz Zentrum München, Munich, Germany.
  • Department of Respiratory, Intensive Care, and Sleep Medicine, Marburg University, Marburg, Germany.
  • German Centre of Infectious Disease Research, Marburg, Germany.
  • Centre for Synthetic Microbiology (Synmikro), Marburg University, Marburg, Germany.

Abstract

INTRODUCTION AND OBJECTIVES

Lower blood eosinophil counts have been associated with increased mechanical ventilation rates in patients with community-acquired pneumonia (CAP). However, the optimal eosinophil count threshold for identifying CAP patients at high risk of respiratory failure remains undefined. This study aimed to establish an optimal admission eosinophil count as a prognostic biomarker for respiratory failure in CAP.

METHODS

This prospective, multicentre cohort study (PROGRESS) enrolled adult patients (≥18 years) hospitalised with community-acquired pneumonia (CAP). A receiver operating characteristic curve analysis with Youden's index was applied to identify the optimal eosinophil threshold for predicting mechanical ventilation. Associations were adjusted for corticosteroid use using multivariable regression. Additional outcomes - ICU admission and hospital length of stay - were compared between patients above and below the optimal eosinophil count threshold.

RESULTS

An eosinophil count threshold of ≤30/µL was optimal for predicting mechanical ventilation. Patients with eosinophil counts ≤30/µL experienced significantly higher mechanical ventilation rates (15.5% versus 7.3%; p < 0.0001; RR 2.12, 95% CI 1.61-2.80), regardless of glucocorticoid treatment. They also exhibited higher ICU admission rates (23.1% versus 10.9%; p < 0.0001; RR 2.11, 95% CI 1.70-2.63) and longer hospital stays among survivors (median 8.0 versus 7.0 days; p < 0.0001).

CONCLUSIONS

Admission eosinopenia (≤30 µL) is a robust, easily measured biomarker that predicts respiratory failure in hospitalised CAP. It supports early risk stratification and may guide timely escalation of care.

MeSH

Blood, Eosinophils, Biomarkers, Pneumonia, Ventilation, Community-Acquired Pneumonia