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Original Research: COPD |

Blood Eosinophils and Outcomes in Severe Hospitalized Exacerbations of COPD

Mona Bafadhel, PhD; Neil J. Greening, PhD; Theresa C. Harvey-Dunstan, PhD; Johanna E.A. Williams, PhD; Michael D. Morgan, PhD; Christopher E. Brightling, PhD; Syed F. Hussain, MD; Ian D. Pavord, MD; Sally J. Singh, PhD; Michael C. Steiner, PhD
Author and Funding Information

Drs Bafadhel and Greening were joint first authors on this manuscript.

FUNDING/SUPPORT: This study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care in Leicestershire, Northamptonshire, and Rutland. The study was conducted at the University Hospitals of Leicester NHS Trust and Kettering General Hospital NHS Foundation Trust. M. B. is funded by a NIHR Post-Doctoral Fellowship. Support was also provided by the NIHR Leicester Respiratory Biomedical Research Unit and Collaboration for Leadership in Applied Health Research and Care in East Midlands and the University of Leicester Clinical Trials Unit.

aRespiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

bCentre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK

cNIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK

dInstitute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK

eKettering General Hospital NHS Foundation Trust, Kettering, UK

fSchool of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK

CORRESPONDENCE TO: Mona Bafadhel, PhD, Respiratory Medicine Unit, NDM Research Building, Old Road Campus Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):320-328. doi:10.1016/j.chest.2016.01.026
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Background  Patients with moderate exacerbations of COPD and the eosinophilic phenotype have better outcomes with prednisolone. Whether this outcome is similar in patients hospitalized with a severe exacerbation of COPD is unclear. We investigated the rate of recovery of eosinophilic and noneosinophilic exacerbations in patients participating in a multicenter randomized controlled trial assessing health outcomes in hospitalized exacerbations.

Methods  Patients were recruited at presentation to the hospital with an exacerbation of COPD. They were stratified into groups according to eosinophilic exacerbations if the peripheral blood eosinophil count on admission was ≥ 200 cells/μL and/or ≥ 2% of the total leukocyte count. Admission details, serum C-reactive protein levels, length of stay, and subsequent rehospitalization data were compared between groups.

Results  A total of 243 patients with COPD (117 men) with a mean age of 71 years (range, 45-93 years) were recruited. The inpatient mortality rate was 3% (median time to death, 12 days; range, 9-16 days). The median absolute eosinophil count was 100 cells/μL (range, 10-1,500 cells/μL), and 25% met our criteria for an eosinophilic exacerbation; in this population, the mean length of stay (in days) was shorter than in patients with noneosinophilic exacerbations (5.0 [range, 1-19] vs 6.5 [range, 1-33]; P = .015) following treatment with oral corticosteroids and independent of treatment prior to admission. Readmission rates at 12 months were similar between groups.

Conclusions  The study patients presenting to the hospital with a severe eosinophilic exacerbation of COPD had a shorter length of stay. The exacerbations were usually not associated with elevated C-reactive protein levels, suggesting that better treatment stratification of exacerbations can be used.

Trial Registry  http://www.isrctn.com/ISRCTN05557928.

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