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Original Research |

Eosinophils in chronic obstructive pulmonary disease exacerbations are associated with increased readmissions

Simon Couillard, MD; Pierre Larivée, MD, FRCPC; Josiane Courteau, PhD; Alain Vanasse, MD, PhD, CMFC
Author and Funding Information

Financial/nonfinancial disclosures: The authors have no conflicts of interest directly relevant to the content of this study. SC has no conflicts of interest to disclose. PL has sponsored research agreements with Boehringer Ingelheim, Novartis, and Sanofi; he has performed consultancy for Boehringer Ingelheim and Merck; and he has received lecture fees from AstraZeneca, Boehringer Ingelheim, Merck, and Novartis. JC has no conflicts of interest to disclose. AV has sponsored research agreements and lecture fees for AstraZeneca and Janssen.

Supported by local funds and the Fonds de Recherche en Santé du Québec

Author contributions: SC: contributed to collection, analysis and interpretation of data, and preparation of the manuscript. PL: contributed to conceiving the study, validating collected data, and reviewing the manuscript. JC: contributed to conceiving the study, collecting data, performing statistics, and reviewing the manuscript. AV: is the guarantor of this study, developed the initial questions and contributed to the development of the protocol, validated collected data, and reviewed and approved the manuscript.

At a Glance Commentary: A subset of patients with chronic obstructive pulmonary disease (COPD) demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophils and poor readmission outcomes are conflicting. The objective of this study was to investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophil levels.

We rigorously analyzed real-world observational data on the eosinophilic COPD phenotype, finding that eosinophil levels ≥ 200 cells/μL and/or ≥ 2% at admission for a severe exacerbation of COPD, when assessed in a time frame free of systemic corticosteroids, is associated with an almost threefold increase in 12-month readmission for COPD, more than double 12-month all-cause readmission, and a shorter time to first COPD-related readmission.

These findings reaffirm that adequately phenotyping specific COPD inflammatory profiles is worthwhile and of clinical importance.

1Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001 12e Avenue Nord, Sherbrooke (Québec), QC J1H 5N4, Canada

2Service de pneumologie du Département de Médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke (Québec), QC J1H 5N4, Canada

3Département de médecine familiale et de médecine d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke (Québec), QC J1H 5N4, Canada

Address for correspondence: Dr Alain Vanasse 12e Avenue Nord, Sherbrooke (Québec), Canada, J1H 5N4.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.003
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Abstract

Rationale  A subset of patients with chronic obstructive pulmonary disease (COPD) demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophils and poor readmission outcomes are conflicting.

Objective  Investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophils.

Methods  With an observational study design, hospitalizations for severe COPD exacerbation were retrospectively gathered. Patient health data previous to and up to one year following the index hospitalization were included. Patients were stratified into the eosinophilic group if the blood eosinophil level on admission was ≥200 cells/μL and/or ≥2% of the total white blood cell count. Clinical outcomes were 12-month COPD-related readmission, 12-month all-cause readmission, length of stay, and time to COPD-related readmission. These outcomes were analysed using logistic, negative binomial, and Cox regression models.

Results  A total of 167 patients were included: 55 with eosinophilia. Eosinophilia was associated with an increased risk of 12-month COPD-related readmission (OR 3.59 [1.65-7.82], p=0.0013), an increased risk of 12-month all-cause readmission (2.32 [1.10-4.92], p=0.0277), and a shorter time to first COPD-related readmission (HR 2.74 [1.56-4.83], p=0.0005). The length of stay was not statistically different between eosinophilic and non-eosinophilic patients. Sensitivity analyses using different eosinophilia definitions reveal a proportional increase in effect size with increasing eosinophil cell count definitions for predicting 12-month readmissions.

Conclusion  Blood eosinophils can be used as a biomarker in severe COPD exacerbations for predicting higher readmission rates.


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