Eosinophilic asthma patients experience longer hospital stays
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Key takeaways:
- Eosinophilic asthma was defined as 300 cells/µL and higher.
- ICU stays were slightly but not significantly longer for eosinophilic patients.
- There was no significant difference in in-hospital mortality rates.
BOSTON — ICU patients with an eosinophilic asthma phenotype had longer ICU and hospital stays compared with patients without an eosinophilic asthma type, according to an abstract presented at the CHEST Annual Meeting.
“Our aim with this study was to explore whether specific markers like blood eosinophil counts could serve as early indicators of risk in critically ill asthma patients,” Sergio Andres Vallejo Avila, MD, internal medicine resident at UT Health San Antonio, told Healio. “Ultimately, we hope that these early investigations will lay the groundwork for future development of scoring tools to help stratify ICU-admitted asthma patients based on their risk.”
This observational study included data from the MIMIC-IV database. It looked at adult patients admitted to the ICU departments at Beth Israel Deaconess Medical Center between 2008 and 2019 with an asthma diagnosis.
Based on their blood eosinophil counts, these patients were then stratified into two groups. The first group included patients with an eosinophilic phenotype ( 300 cells/µL), and the second included patients with a non-eosinophilic phenotype (< 300 cells/µL).
Among the 1,089 patients in the study, 226 (20.6%) had an eosinophilic phenotype and 863 (79.2%) did not. Eosinophilic patients had a median eosinophilic count of 440 cells/µL (interquartile range [IQR], 363-569) whereas non-eosinophilic patients had a median eosinophilic count of 90 cells/µL (IQR, 39-171).
Eosinophilic patients and non-eosinophilic patients showed no significant difference in in-hospital mortality rates (11% vs 11.8%). Eosinophilic patients had slightly but not significantly longer ICU stays (2.9 days; IQR, 1-6 vs. 2.5 days; IQR, 1.3-5.1) but significantly longer overall hospital stays (median, 12 days; IQR, 7-18 vs. 9 days; IQR, 7-15; P < .001).
“While the eosinophilic phenotype did not correlate with increased in-hospital mortality, it was significantly associated with a longer hospital length of stay,” Vallejo Avila said. “This was an important finding, as it suggests that although mortality rates may not differ, the eosinophilic phenotype may still be a marker for prolonged hospitalization, which has its own implications for health care resource utilization and patient outcomes.”
Vallejo Avila further highlighted that the finding that eosinophilic patients had longer hospital stays, but no difference in mortality, was surprising because the eosinophilic phenotype is often associated with more severe asthma in outpatient settings.
“This suggests that while mortality may not be affected, these patients still require more intensive care and longer hospitalization, emphasizing the importance of phenotype-specific management strategies,” he said.
According to Vallejo Avila, these findings can help inform clinicians on how to better manage ICU-admitted asthma patients.
“For patients with the eosinophilic phenotype, knowing they are likely to experience longer hospital stays could prompt early, targeted interventions that may reduce their overall length of stay,” he said. “Tracking eosinophil levels can also guide decisions about anti-inflammatory treatments, such as corticosteroids or biologics, to modulate the immune response appropriately.”
Vallejo Avila added that future research should focus on validating these markers as independent prognostic factors and refining them into practical scoring systems that can be used in real-time clinical decision-making.
“On a broader scale, public health policies could evolve to incorporate these findings into ICU management protocols for asthma patients, optimizing resource allocation and potentially improving survival rates for critically ill asthma patients,” he said.