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Obstructive Lung Diseases |

Peripheral Blood Eosinophilia, a Marker for Corticosteroid Responsiveness in Patients Hospitalized With Acute Exacerbation of COPD (AECOPD)

Victor Cardenas, MD; Li Zeng, PhD; Gulshan Sharma, MD
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University of Texas Medical Branch, Galveston, TX


Chest. 2013;144(4_MeetingAbstracts):710A. doi:10.1378/chest.1704304
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Abstract

SESSION TITLE: COPD Diagnosis & Evaluation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Corticosteroids are a mainstay of treatment for patients hospitalized with acute exacerbation of COPD. Diseases with eosinophilic inflammation often demonstrate a robust response to corticosteroids. We hypothesize that patients hospitalized with AECOPD who had peripheral blood eosinophilia (PBE) on presentation respond earlier to corticosteroid therapy

METHODS: We conducted a retrospective review of patients admitted to the UTMB hospitals from January 2009 to September 2012. Inclusion criteria were a discharge diagnosis of AECOPD and having received at least one dose of corticosteroids during the hospital stay. Groups were separated by the presence or absence of PBE, defined as ≥ 2% eosinophils on peripheral blood count at admission. Demographic data, hospital medication use, and outcome measures were recorded. Primary outcome was hospital length of stay. T-test and chi-sq test were used to compare continuous and categorical variables, respectively. A p-value <0.05 was considered statistically significant.

RESULTS: 416 patients met inclusion criteria. Of these, 131 patients (31.4%) demonstrated PBE. Patients with PBE were more likely to be male, African American, and have a history of illicit drug use. Length of stay (mean +/- STD) was significantly shorter for patients with PBE, 2.61 +/- 1.88 vs non PBE 4.23 +/- 6.34, p < 0.0001. Total corticosteroid dose in the first 48 hours was not significantly different between groups.. 30 day readmission rates for COPD exacerbation were significantly higher in the PBE group (14.5% vs. 7.7%, p = 0.047). There was no difference in all cause 30-day readmission rates (22.1% vs. 21%, p = 0.903).

CONCLUSIONS: Peripheral blood eosinophilia may help identify patients with AECOPD who respond more rapidly to corticosteroids but is associated with higher 30-day readmission rates for COPD exacerbation.

CLINICAL IMPLICATIONS: Clinical Implications: 1. Patients with AECOPD and PBE may require prolonged therapy with corticosteroid therapy to prevent recurrence. 2. The possibility of an allergic component and more frequent recurrence should trigger review for possible environmental triggers. 3. The use of corticosteroids in patients without PBE may need to be reconsidered.

DISCLOSURE: The following authors have nothing to disclose: Victor Cardenas, Li Zeng, Gulshan Sharma

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