Chest
Original Research: COPDEosinophils in COPD Exacerbations Are Associated With Increased Readmissions
Section snippets
Study Design
With an observational study design, all severe exacerbations of COPD in the hospital health centers of Sherbrooke, Quebec, Canada, between April 1, 2012, and March 31, 2013, were retrospectively screened through electronic medical records. The main diagnosis of hospitalization had to be registered as “acute exacerbation of COPD,” with no mention of decompensated asthma in this field and no comorbid bronchiectasis elsewhere. Patients had to have survived the index hospitalization. The
Results
A total of 447 candidate hospitalizations were included, and 236 were retained after applying exclusion criteria. From these, 167 patients had a corticosteroid-free CBC count available (Fig 1). Patient characteristics are presented in Table 1. Fifty-five patients had eosinophilia as defined by the cutoff of ≥ 200 cells/μL and/or ≥ 2%. Except for eosinophil counts, none of the differences between eosinophilic and noneosinophilic patients was statistically significant.
Discussion
The main finding of the present study was that an increased eosinophil count at admission, when defined by using a cutoff of ≥ 200 cells/μL and/or ≥ 2% of the WBC count, can predict a more than threefold increase in 12-month readmission for COPD, a more than double increase in 12-month all-cause readmission, and a shorter time to first COPD-related readmission. The influence of eosinophil cell counts on readmissions was consistent throughout the sensitivity analyses conducted on our data.
Conclusions
We found that higher blood eosinophil counts at admission for severe exacerbation of COPD, when assessed in a corticosteroid-free time frame, was associated with a more than threefold increase in 12-month readmission for COPD, a 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.
Acknowledgments
Author contributions: A. V. is the guarantor of this study; he developed the initial questions; and contributed to the development of the protocol, validated the collected data, and reviewed and approved the manuscript. S. C. contributed to collection, analysis and interpretation of data, and preparation of the manuscript. P. L. contributed to conceiving the study, validating collected data, and reviewing the manuscript. J. C. contributed to conceiving the study, collecting data, performing
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2023, Respiratory MedicineCitation Excerpt :The selection procedure is illustrated in Fig. 1. A total of 46 studies [16–61] were included, of which 21, 9, 13, 2, and 1 were conducted in European region, Western Pacific region, Americas region, Eastern Mediterranean region, and Non-member observer country or region, respectively, based on the WHO regions. The included studies were published from 2001 to 2022, with 19 prospective and 27 retrospective studies.
FUNDING/SUPPORT: This work was supported by local funds and the Fonds de Recherche en Santé du Québec.