Blood eosinophil count predicts treatment failure and hospital readmission for COPD.

Marjan Kerkhof,Tamsin Morris,Marc Miravitlles,Rupert Jones,Alan Kaplan,David B Price,Ian D Pavord,Chin Kook Rhee,Janwillem Kocks,David M.G Halpin,Isha Chaudhry,Omar S Usmani,Marianna Alacqua

doi:10.1183/23120541.00188-2020

Abstract

We examined associations between blood eosinophil counts (BEC) and risk of treatment failure or hospital readmission following acute oral corticosteroid (OCS)-treated COPD exacerbations.We conducted studies from the Optimum Patient Care Research Database (OPCRD) (www.optimumpatientcare.org/opcrd) and Clinical Practice Research Datalink (CPRD) (www.cprd.com/home/), validated databases for medical research, with linked Hospital Episode Statistics (HES) data for ∼20 000 COPD patients aged ≥40 years. For patients with OCS-treated COPD exacerbations treated in primary care, with BECs recorded on first day of OCS treatment (Cohort 1), we assessed treatment failure (COPD-related hospitalisations and OCS prescriptions beyond index OCS course). For patients hospitalised for COPD exacerbations, with BEC measured over an exacerbation-free period during the year prior to admission (Cohort 2), we assessed readmission rate. Cox proportional hazards regression analysis was adjusted for confounders to estimate the association between BEC and treatment outcomes.Of patients treated with OCS for COPD exacerbations in primary care (Cohort 1), 44% experienced treatment failure following single OCS courses, and 10% (255/2482) were hospitalised for ≤6 weeks. Greater BEC was associated with reduced hospital-admission risk (hazard ratio [HR]=0.26; 95% CI: 0.12–0.56, per 100 cells·µL−1 increase). BEC increases of ≥200 cells·µL−1 from exacerbation-free periods to exacerbations were associated with least hospitalisation risk (HR=0.32; 95% CI: 0.15–0.71) versus no BEC change. For patients hospitalised for COPD exacerbations (Cohort 2), 4-week hospital readmission was 12% (1189/10 245). BEC increases during an exacerbation-free period within the past year were associated with reduced risk of short-term readmission (HR=0.78; 95% CI: 0.63–0.96).Greater BEC predicted better outcomes for patients with OCS-treated COPD exacerbations, whether community or hospital managed. Eosinopenia predicted worse outcomes.

Highlights

COPD is a prevalent, complex and heterogeneous disease with limited treatment success for some patients [1]
Patients treated with oral corticosteroids for COPD exacerbations in a primary-care setting (Cohort 1) Index years for patients treated in a primary-care setting (Cohort 1) ranged from 2005 to 2017
Association between blood eosinophil counts (BEC) and oral corticosteroid-treated COPD exacerbation and treatment failure For patients treated with OCS for COPD exacerbations in a primary-care setting (Cohort 1), an association was observed between BEC on the day of an OCS-treated COPD exacerbation in primary care and the risk of subsequent hospitalisation for COPD exacerbation

Summary

Introduction

COPD is a prevalent, complex and heterogeneous disease with limited treatment success for some patients [1]. Many patients with COPD experience exacerbations, which contribute to disease progression, especially if recovery from exacerbations is slow [2, 3]. COPD exacerbations can be heterogeneous in aetiology and underlying inflammation [2]. Systemic corticosteroids are recommended for the treatment of COPD exacerbations because they can shorten recovery time and hospitalisation duration and increase time to a subsequent exacerbation [3, 4]. Systemic corticosteroids are associated with known adverse events. Treatment strategies targeted at the needs of individual patients may improve treatment-related clinical outcomes [1]

Methods

Results

Conclusion