J Allergy Clin Immunol Pract . Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness

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J Allergy Clin Immunol Pract


. 2021 Jan 22;S2213-2198(20)31409-4.
doi: 10.1016/j.jaip.2020.12.045. Online ahead of print.
Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness


Denisa Ferastraoaru ¹ , Golda Hudes ² , Elina Jerschow ² , Sunit Jariwala ² , Merhunisa Karagic ² , Gabriele de Vos ² , David Rosenstreich ² , Manish Ramesh ²



Affiliations

• PMID: 33495097
• DOI: 10.1016/j.jaip.2020.12.045

Abstract

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.

Keywords: Asthma; COVID-19; Eosinophilia; Mortality.