| Objective: Chronic obstructive pulmonary disease（COPD）was a highly heterogeneous disease,and it was crucial to find potential biomarkers to identify patients with COPD who benefit from inhaled glucocorticoid（ICS）therapy.It has been suggested that blood eosinophils（EOS）could be used as a predictive biomarker of ICS treatment efficacy.However,the use of blood eosinophils to predict ICS treatment responsiveness remains controversial and needs further validation.Nevertheless,in this study,Meta-analysis was used to investigate the clinical significance of blood eosinophils count in guiding inhaled glucocorticoid therapy in patients with chronic obstructive pulmonary disease.Methods: A comprehensive search of studies related to blood eosinophils count guiding the application of inhaled glucocorticoids in COPD patients was performed by a combination of medical terms and free words in Pub Med,The Cochrane Library,Embase,Web of Science,CNKI,Wan Fang Data,CBM,and VIP databases,and a manual search of The EOS thresholds assessed were relative blood eosinophil count 2%,absolute blood eosinophil count 150 cells/μL and 300 cells/μL.The latest search was updated on July 5,2021.Data were retrieved based on inclusion and exclusion criteria and included studies were evaluated for quality.Statistical analysis was accomplished with R software 4.1.1 and Rev Man 5.3.Results: A total of 15 publications involving 40,120 patients with chronic obstructive pulmonary disease were included in this study.The results showed that for EOS ≥ 2%[RR = 0.87,95%CI（0.78,0.96）,P = 0.006],BEC ≥ 150 cells/μL [RR = 0.75,95% CI（0.60,0.94）,P = 0.0.01],BEC < 150 cells/μL [RR = 0.83,95% CI（0.74,0.92）,P =0.0005] in COPD patients,ICS treatment reduced the risk of moderate/severe exacerbation compared to non-ICS treatment,with a statistically significant difference.In COPD patients with EOS < 2%,BEC ≥ 300 cells/μL,and BEC < 300 cells/μL,there was no statistically significant difference in the risk of moderate/severe exacerbation between ICS-containing and non-ICS therapy.For COPD patients with EOS ≥ 2%[HR = 1.18,95% CI（1.07,1.30）,P = 0.001] and BEC ≥ 300 cells/μL [HR = 1.62,95%CI（1.25,2.10）,P = 0.0002],treatment with ICS extended the time to first moderate/severe exacerbation.The risk of pneumonia events was significantly increased in COPD patients with EOS ≥ 2% treated with ICS-containing therapy [RR =2.19,95% CI（1.55,3.10）,P < 0.0001] and was not significantly different in COPD patients with EOS < 2% [RR = 1.26,95% CI（0.88,1.80）,P = 0.210].Conclusions: Our study suggests that blood eosinophil counts can be used as a biomarker of COPD prognosis and that a relative eosinophil count ≥ 2% predicts treatment response to ICS in COPD patients and may be a threshold for ICS for COPD,but increases the risk of pneumonia.In addition,the therapeutic response to ICS in COPD patients should be assessed by stratification according to the absolute eosinophil count range rather than a single absolute eosinophil threshold. |
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