TY - JOUR
T1 - Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness
AU - Ferastraoaru, Denisa
AU - Hudes, Golda
AU - Jerschow, Elina
AU - Jariwala, Sunit
AU - Karagic, Merhunisa
AU - de Vos, Gabriele
AU - Rosenstreich, David
AU - Ramesh, Manish
N1 - Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology
PY - 2021/3
Y1 - 2021/3
N2 - Background: There is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics. Objective: To identify risk factors associated with admission and subsequent mortality among COVID-19–infected asthmatics. Methods: Adults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded. Results: In total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained <150 cells/μL (n = 213) (mortality rate 9.6% vs 25.8%; OR = 0.006, 95% CI: 0.0001-0.64, P = .03). This group had also higher preadmission mean AEC (237 ± 181 vs 163 ± 147 cells/μL, P = .001, OR = 2012, 95% CI: 27.3-14,816). The mortality rate in patients with asthma alone (no associated CHF, CKD, COPD, diabetes, or hypertension) was similar to that of patients without asthma or any of these comorbidities. Conclusions: In asthmatics, pre-existing eosinophilia (AEC ≥150 cells/μL) was protective from COVID-19–associated admission, and development of eosinophilia (AEC ≥150 cells/μL) during hospitalization was associated with decreased mortality. Preadmission AEC influenced the AEC trend during hospitalization. Having a Th2-asthma phenotype might be an important predictor for reduced COVID-19 morbidity and mortality that should be further explored in prospective and mechanistic studies.
AB - Background: There is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics. Objective: To identify risk factors associated with admission and subsequent mortality among COVID-19–infected asthmatics. Methods: Adults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded. Results: In total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained <150 cells/μL (n = 213) (mortality rate 9.6% vs 25.8%; OR = 0.006, 95% CI: 0.0001-0.64, P = .03). This group had also higher preadmission mean AEC (237 ± 181 vs 163 ± 147 cells/μL, P = .001, OR = 2012, 95% CI: 27.3-14,816). The mortality rate in patients with asthma alone (no associated CHF, CKD, COPD, diabetes, or hypertension) was similar to that of patients without asthma or any of these comorbidities. Conclusions: In asthmatics, pre-existing eosinophilia (AEC ≥150 cells/μL) was protective from COVID-19–associated admission, and development of eosinophilia (AEC ≥150 cells/μL) during hospitalization was associated with decreased mortality. Preadmission AEC influenced the AEC trend during hospitalization. Having a Th2-asthma phenotype might be an important predictor for reduced COVID-19 morbidity and mortality that should be further explored in prospective and mechanistic studies.
KW - Asthma
KW - COVID-19
KW - Eosinophilia
KW - Mortality
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U2 - 10.1016/j.jaip.2020.12.045
DO - 10.1016/j.jaip.2020.12.045
M3 - Article
C2 - 33495097
AN - SCOPUS:85099808865
SN - 2213-2198
VL - 9
SP - 1152-1162.e3
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 3
ER -
