Eosinophils in COPD Exacerbations Are Associated With Increased Readmissions
Eosinophils in COPD Exacerbations Are Associated With Increased Readmissions
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DOI：
10.1016/j.chest.2016.10.003
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发表时间：
2017-02-01
期刊：
影响因子：
9.6
通讯作者：
Vanasse, Alain
中科院分区：
文献类型：
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作者：
Couillard, Simon;Larivee, Pierre;Vanasse, Alain
背景：一部分慢性阻塞性肺病患者的痰或血液中表现出嗜酸性粒细胞炎症。先前关于血液嗜酸性粒细胞水平升高与再入院结局不佳之间关系的研究是相互矛盾的。本研究的目的是调查血液嗜酸性粒细胞水平较高的患者慢性阻塞性肺病严重恶化后的结果。方法：通过观察性研究设计，回顾性收集因慢性阻塞性肺病严重恶化住院的数据。包括指数住院之前和之后一年内的患者健康数据。如果入院时血液嗜酸性粒细胞水平≥200个细胞/mL和/或≥白细胞总数的2%，则将患者分层至嗜酸性粒细胞组。临床结果包括 12 个月 COPD 相关再入院、12 个月全因再入院、住院时间以及 COPD 相关再入院时间。使用 Logistic、负二项式和 Cox 回归模型对这些结果进行分析。 结果：总共纳入 167 名患者； 55 人患有嗜酸性粒细胞增多。嗜酸性粒细胞增多与 12 个月 COPD 相关再入院风险增加（OR，3.59 [95% CI，1.65-7.82]；P = .0013）、12 个月全因再入院风险增加（2.32 [95% CI，1.10-4.92]；P = .0277）以及首次出现 COPD 相关事件的时间较短相关。再入院（风险比，2.74 [1.56-4.83]；P = .0005）。嗜酸性粒细胞和非嗜酸性粒细胞患者的住院时间没有统计学差异。使用不同嗜酸性粒细胞定义的敏感性分析显示，随着嗜酸性粒细胞计数定义的增加，预测 12 个月再入院的效应大小成比例增加。结论：血液嗜酸性粒细胞水平可用作 COPD 严重急性加重的生物标志物，用于预测更高的再入院率。
BACKGROUND: A subset of patients with COPD demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophil levels and poor readmission outcomes are conflicting. The goal of this study was to investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophil levels.METHODS: With an observational study design, data on hospitalizations for severe COPD exacerbation were retrospectively gathered. Patient health data previous to and up to 1 year following the index hospitalization were included. Patients were stratified into the eosinophilic group if the blood eosinophil level on admission was >= 200 cells/mL and/or >= 2% of the total WBC 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 analyzed by using logistic, negative binomial, and Cox regression models.RESULTS: A total of 167 patients were included; 55 had eosinophilia. Eosinophilia was associated with an increased risk of 12-month COPD-related readmission (OR, 3.59 [95% CI, 1.65-7.82]; P = .0013), an increased risk of 12-month all-cause readmission (2.32 [95% CI, 1.10-4.92]; P = .0277), and a shorter time to first COPD-related readmission (hazard ratio, 2.74 [1.56-4.83]; P = .0005). The length of stay was not statistically different between eosinophilic and noneosinophilic patients. Sensitivity analyses using different eosinophilia definitions revealed a proportional increase in effect size with increasing eosinophil cell count definitions for predicting 12-month readmissions.CONCLUSIONS: Blood eosinophil levels can be used as a biomarker in severe COPD exacerbations for predicting higher readmission rates.