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Leukocytosis in Patients With COPD/BA Exacerbation: Steroid-Induced or Sign of an Infection? FREE TO VIEW

Bikash Bhattarai; Meenakshi Ghosh; Abhisekh Sinha Ray; Mohammed Raihan Azad; Bhradeev Sivasambu; Sai Kwan Wan; Santu Saha; Saroj Kandel; Prakash Kharel; Saurav Pokharel; Rakesh Vadde; Vikram Oke; Marie Frances Schmidt; Danilo Enriquez; Joseph Quist; Anita Pandey; Saveena Manhas
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Interfaith Medical Center, Brooklyn, NY

Chest. 2014;146(4_MeetingAbstracts):28A. doi:10.1378/chest.1993849
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SESSION TITLE: COPD Diagnosis and Evaluation Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Steroids can cause leukocytosis by both demarginalization and increased release from bone marrow reserve. Leukocytosis is a potential confounder in COPD/BA patients (pts) who are on steroid therapy and are suspected of having a concomitant bacterial infection. In these pts, it is often unclear whether the leukocytosis is due to steroids or to the infection; with this in mind we designed the following study.

METHODS: Data from 1200 pts admitted with obstructive lung disease was collected. Indicators for infection included radiological evidence of lung infiltrate, positive cultures (blood, sputum or other) and fever (T>100.40F). Serial WBC count was done to document leukocyte trends. 1064 pts with acute exacerbation were divided into 3 groups based on presence of infection and institution of steroid therapy. The groups included pts with infection and on steroids (n=362), pts with infection and not on steroids (n=58), and pts without infection and on steroids (n=644). The remaining 136 pts were admitted for non-infectious reasons, were not given steroids and were used as a control group. Empiric antibiotics and steroids were given as indicated and a one-way ANOVA was used to compare mean changes in WBC counts between these 4 groups.

RESULTS: Our study population was 44% male and 88% African American. Mean age was 62.7. 34% of pts had infection (based on radiology 21%, blood culture 12%, other culture 9% and fever 5.3%). Mean increase in WBC count in the control group was 500/µL, in the steroid only group it was 4100/µL and in the steroid and infection group it was 2990/µL. There was a decrease of 1600/µL in mean WBC count in the infection only group. The change in mean WBC counts among these four groups [F(3,1193)=14.531, p<.05] was statistically significant. Tukey post-hoc comparisons indicated that the infection plus steroid group and the steroid only group were the only two groups to have statistically significant changes in WBC counts when compared to the control group

CONCLUSIONS: Steroid therapy significantly increases WBC count. Our study indicated that pts with infection who were on steroid therapy had a blunted leukocyte response in comparison to those without infection and on steroid therapy. However, we attribute this finding to the use of empiric antibiotics with presumed infection.

CLINICAL IMPLICATIONS: Based on our results, we conclude that leukocytosis alone is not a reliable predictor of infection in COPD/BA pts on steroid therapy.

DISCLOSURE: The following authors have nothing to disclose: Bikash Bhattarai, Meenakshi Ghosh, Abhisekh Sinha Ray, Mohammed Raihan Azad, Bhradeev Sivasambu, Sai Kwan Wan, Santu Saha, Saroj Kandel, Prakash Kharel, Saurav Pokharel, Rakesh Vadde, Vikram Oke, Marie Frances Schmidt, Danilo Enriquez, Joseph Quist, Anita Pandey, Saveena Manhas

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