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Weckler, B.* ; Martin, R.J.* ; Kutzinski, M.* ; Bertrams, W.* ; Jung, A.L.* ; Pott, H.* ; Laakmann, K.* ; Schulte, L.N.* ; Ahnert, P.* ; Heider, D.* ; Ringshandl, S.* ; Seidemann, C.* ; Suttorp, N.* ; Witzenrath, M.* ; Wildberg, J.* ; Lehmann, M. ; Rohde, G.* ; Greulich, T.* ; Vogelmeier, C.* ; Schmeck, B.*

Eosinophil count as biomarker for risk stratification of community-acquired pneumonia: a prospective cohort study.

Pneumologie 79, S92 - S93 (2025)

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Background: Retrospective evidence suggests that eosinopenia is associated with worse outcomes in patients with community-acquired pneumonia (CAP). However, data about the relationship between blood eosinophil levels and well-established risk stratification scores for CAP are missing, and a suitable eosinophil count threshold for distinguishing high- from low-risk patients has not been determined yet. This study therefore investigated blood eosinophil count at hospital admission as a biomarker for risk stratification of CAP. Methods: Adult patients were recruited in a prospective observational multi-centre study on hospitalised CAP (PROGRESS). The correlation between blood eosinophil numbers at hospital admission as continuous variable and risk stratification scores was analysed. A continuous analysis of eosinophil numbers versus mortality and risk of mechanical ventilation was performed for threshold determination of eosinopenia as a biomarker for risk stratification. Based on this analysis, patients were allocated to an eosinopenia (≤ 50/µL) and non-eosinopenia (> 50/µL) group. Their baseline characteristics and outcomes were compared. Findings: Overall, 1763 (60.0% males, median age 63.0 years) patients were included. Eosinophil counts correlated inversely with CRB-65 (p<0·0001), CURB-65 (p<0·0001), PSI (p<0·0001), Infectious Disease Society of America/American Thoracic Society minor criteria (p<0·0001), SOFA (p<0·0001), and Quick SOFA (p=0·0155). An eosinophil count threshold of 50/µL was proven suitable for risk stratification: Eosinopenia (versus non-eosinopenia) was associated with increased in-hospital mortality (2·8% versus 1·2%; RR 2·29; p=0·0251), need for mechanical ventilation (14·7% versus 7·1%; RR 2·07; p<0·0001), and length of stay (8 versus 7 days; p=0·0048). After compensating for multiple confounders including glucocorticoid treatment in the multivariate analysis, eosinopenia≤50/µL (versus non-eosinopenia) correlated with an increased (p=0·0003) need for mechanical ventilation. Interpretation: In a prospective multicentre study, blood eosinophil count at hospital admission correlates with well-established risk stratification scores for CAP. Eosinopenia≤50/µL seems to be a promising biomarker for risk stratification.

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