Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study
Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study
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DOI：
10.1016/s2213-2600(15)00367-7
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发表时间：
2015-11-01
影响因子：
76.2
通讯作者：
Pavord, Ian D.
中科院分区：
文献类型：
--
作者：
Price, David B.;Rigazio, Anna;Pavord, Ian D.
背景：痰嗜酸性粒细胞计数升高可预测哮喘加重和吸入皮质类固醇的反应性，但在初级保健中测量是不切实际的。我们研究了英国一个大型队列中嗜酸性粒细胞计数与预期年度哮喘结局之间的关系。方法本历史队列研究采用匿名病历资料，对12-80岁的哮喘病初级保健患者进行2年连续记录，包括其最近嗜酸性粒细胞计数前1年（基线）和后1年（结果）。采用负二项回归比较结果加重率，并采用logistic回归比较嗜酸性粒细胞计数≥400细胞/ μ L与≥400细胞/ μ L患者哮喘控制的几率，调整年龄、性别、体重指数、吸烟状况和Charlson合病指数。该研究已在ClinicalTrials.gov注册，编号NCT02140541。总体而言，130248例患者中，20929例（16%）患者的血嗜酸性粒细胞计数大于400个/ μ L。在结果年内，这些患者比计数为400个/ μ L或更少的患者经历了更严重的恶化（校正率比[RR] 1.42, 95% CI 1.36-1.47）和急性呼吸事件（RR 1.28, 1.24-1.33）。他们实现总体哮喘控制的几率也明显较低（OR 0.74, 95% CI 0.72-0.77），定义为有限的缓解剂使用，没有哮喘相关的住院或住院，没有口服皮质类固醇的急性病程，也没有抗生素处方。与每μ L 200细胞或更少的参考类别相比，随着9个类别的血液嗜酸性粒细胞计数的上升，恶化率逐渐增加。哮喘患者和血液嗜酸性粒细胞计数大于400细胞/ μ L经历更严重的恶化和哮喘控制较差。此外，血液嗜酸性粒细胞计数与哮喘相关结果之间存在计数反应关系。血液嗜酸性粒细胞计数可以为全球哮喘控制风险评估倡议增加预测价值。
Background Elevated sputum eosinophil counts predict asthma exacerbations and responsiveness to inhaled corticosteroids but are impractical to measure in primary care. We investigated the relation between blood eosinophil count and prospective annual asthma outcomes for a large UK cohort.Methods This historical cohort study used anonymised medical record data to identify primary care patients with asthma aged 12-80 years with 2 years of continuous records, including 1 year before (baseline) and 1 year after (outcome) their most recent eosinophil count. Negative binomial regression was used to compare outcome exacerbation rates and logistic regression to compare odds of asthma control for patients with blood eosinophil counts of 400 cells per mu L or less versus greater than 400 cells per mu L, adjusting for age, sex, body-mass index, smoking status, and Charlson comorbidity index. The study is registered at ClinicalTrials.gov, number NCT02140541.Findings Overall, 20 929 (16%) of 130 248 patients had blood eosinophil counts greater than 400 cells per mu L. During the outcome year, these patients experienced significantly more severe exacerbations (adjusted rate ratio [RR] 1.42, 95% CI 1.36-1.47) and acute respiratory events (RR 1.28, 1.24-1.33) than those with counts of 400 cells per mu L or less. They also had significantly lower odds of achieving overall asthma control (OR 0.74, 95% CI 0.72-0.77), defined as limited reliever use and no asthma-related hospital attendance or admission, acute course of oral corticosteroids, or prescription for antibiotics. Exacerbation rates increased progressively with nine ascending categories of blood eosinophil count as compared with a reference category of 200 cells per mu L or less.Interpretation Patients with asthma and blood eosinophil counts greater than 400 cells per mu L experience more severe exacerbations and have poorer asthma control. Furthermore, a count response relation exists between blood eosinophil counts and asthma-related outcomes. Blood eosinophil counts could add predictive value to Global Initiative for Asthma control-based risk assessment.