Peripheral Blood Eosinophilia and Neutrophil Lymphocyte Ratio in the Choice of Antibiotic and/or Steroid in Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

Objective: The choice of steroids and antibiotics is optional for the management of acute exacerbation of chronic obstructive pul- monary diseases according to international guidelines. The study hypothesized that the steroid and antibiotic choice can be decided by using the neutrophil-lymphocyte ratio and peripheral blood eosinophilia in patients with acute exacerbation of chronic obstructive pulmonary diseases. This would reduce the rate of re-hospitalization in 28 days.

Material and methods: Patients were hospitalized due to acute exacerbation of chronic obstructive pulmonary diseases from February 1, 2018, to January 31, 2019. Patients were divided into 2 groups: Sureyyapasa protocol group and conventional group. In the Sureyyapasa protocol group, patients were divided into 4 subgroups according to peripheral blood eosinophilia and neutrophil-lympho- cyte ratio values. Treatment success was defined as 5-7 days acute exacerbation of chronic obstructive pulmonary diseases treatment was enough to discharge and no re-hospitalization within 28 days. Treatment failure was defined that the hospital stay was longer than 7 days or transport to intensive care and death or readmission to the hospital due to acute exacerbation of chronic obstructive pulmonary diseases within 28 days after discharge.

Results: The Sureyyapasa protocol group (n = 96) and the conventional group (n = 95) were randomly selected. The conventional group and Sureyyapasa protocol group had similar hospital stay (P = .22), and antibiotic and steroid uses were significantly higher in the conventional group than the Sureyyapasa protocol group (antibiotic use 100% vs. 83%, P < .001 and steroid use 84% vs. 29%, P < .001, respectively). Treatment failure in the conventional Group (n = 23, 24%) is higher than the Sureyyapasa protocol group (n = 17, 18%).

Conclusions: Initiating treatment by evaluating eosinophilia and neutrophil-lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary diseases in the ward reduces unnecessary antibiotic and steroid use and cost rates in hospitalizations.