PURPOSE: Leukocytes are often found to be increased in patients treated with corticosteroids. This study was conducted to evaluate quantitative changes in total leukocyte count (TLC), neutrophil, lymphocyte and eosinophil counts following corticosteroid administration in patients on mechanical ventilator due to COPD exacerbation.
METHODS: We retrospectively reviewed 120 COPD cases admitted with acute exacerbation between August 2005 and August 2009. Inclusion criteria: age more than 18 years, normal TLC on admission and steroids administered daily for atleast first 3 days. Exclusion criteria: fever and/or new chest X-ray infiltrates on admission, patients on chronic oral steroids, immunocompromised states and malignancy. Total leukocyte count, neutrophil, lymphocyte and eosinophil counts during first three days following admission were recorded and compared by using Bonferoni t-test.
RESULTS: The leukocyte count (mean ± standard deviation, per cubic millimeter) increased from 7990 ± 920 (day 1) to 9350 ± 1100 (day 2), and to 14310 ± 2450 (day 3) (p< 0.0001). The neutrophil count (mean ± standard deviation, per cubic millimeter) increased from 4910 ± 1920 (day 1) to 7820 ± 1420 (day 2), and to 12310 ± 3150 (day 3) (p< 0.0001). The lymphocyte count (mean ± standard deviation, per cubic millimeter) decreased from 1980 ± 1250 (day 1) to 730 ± 220 (day 2) (p< 0.0001), followed by an increase from 730 ± 220 to 1500 ± 750 (day 3) (p< 0.0005). The eosinophil count (mean ± standard deviation, per cubic millimeter) decreased from 510 ± 320 (day 1) to 410 ± 110 (day 2), and to 110 ± 50 (day 3) (p< 0.0001).
CONCLUSION: In the absence of active infection at the time of admission, leukocyte dynamics follows a predictable pattern on initiation of steroid treatment in mechanically ventilated COPD exacerbation patients. This pattern is quite helpful in evaluating infections or non-responsiveness to treatment in the described set of patients.
CLINICAL IMPLICATIONS: Awareness of leukocyte dynamics following steroid administration can prevent unnecessary use of antibiotics.
DISCLOSURE: Amit Bansal, No Financial Disclosure Information; No Product/Research Disclosure Information