血嗜酸性粒细胞水平升高的哮喘负担。
Burden of asthma with elevated blood eosinophil levels.
作者信息
Casciano Julian, Krishnan Jerry A, Small Mary Buatti, Buck Philip O, Gopalan Gokul, Li Chenghui, Kemp Robert, Dotiwala Zenobia
机构信息
eMAX Health LLC, 445 Hamilton avenue, 11th floor, White Plains, NY, 10601, USA.
Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA.
出版信息
BMC Pulm Med. 2016 Jul 13;16(1):100. doi: 10.1186/s12890-016-0263-8.
BACKGROUND
Asthma is a common chronic condition with an economic burden of almost $56 billion annually in the US. Biologic markers like blood eosinophils, that help predict the risk of exacerbation could help guide more optimal treatment plans and reduce cost. The purpose of this study was to determine whether healthcare resource use and expenditures vary by eosinophil level among patients with asthma.
METHODS
Patients with a diagnosis of asthma defined by ICD-9-CM code 493.xx between January 2004 and July 2011 were extracted from EMRClaims + database (eMAX Health, White Plains NY). Patients were classified as mild, moderate, or severe by medication use following diagnosis, based on recommendations of National Institutes of Health Expert Panel Report 3. Patients were classified as those with elevated eosinophils (≥400 cells/μL) and normal eosinophil level (<400 cells/μL). Patients were followed for resource use, defined as hospitalizations, ER visits and outpatient visit and associated costs were calculated to assess whether an economic difference exists between eosinophil groups. Non-parametric tests were used to compare resource use and associated cost between elevated and normal eosinophil groups. Multivariate modeling was performed to assess the contribution of eosinophil level on the likelihood of study outcomes among patients with severe asthma.
RESULTS
Among the 2,164 patients meeting eligibility criteria, 1,144 had severity designations. Of these, 179(16 %) of patients had severe asthma of which 20 % (n = 35) had elevated eosinophils. Seventeen percent of patients with elevated eosinophils were admitted to the hospital during the follow-up period, significantly greater than patients with normal eosinophil levels (12 %; p = 0.011). Overall, compared to patients with normal eosinophil levels (n = 1734), patients with elevated eosinophil levels (n = 430) had significantly greater mean annual hospital admissions (0.51 vs. 0.21/year, p = 0.006) and hospital costs (2,536 vs. $1,091, p = 0.011). Logistic regressions showed that elevated eosinophil level was associated with 5.14 times increased odds of all cause admissions (95 % CI:1.76-14.99, p = 0.003) and 4.07 times increased odds of asthma related admissions (95 % CI: 1.26-13.12, p = 0.019).
CONCLUSION
Eosinophil elevation was associated with greater healthcare resource use in patients with asthma.
背景
哮喘是一种常见的慢性疾病，在美国每年造成近560亿美元的经济负担。像血液嗜酸性粒细胞这样的生物标志物有助于预测病情加重的风险，可帮助指导更优化的治疗方案并降低成本。本研究的目的是确定哮喘患者中医疗资源的使用和支出是否因嗜酸性粒细胞水平而异。
方法
从EMRClaims +数据库（eMAX Health，纽约州白原市）中提取2004年1月至2011年7月期间由ICD-9-CM代码493.xx定义为哮喘诊断的患者。根据美国国立卫生研究院专家小组报告3的建议，患者在诊断后根据用药情况分为轻度、中度或重度。患者被分为嗜酸性粒细胞升高（≥400个细胞/μL）和嗜酸性粒细胞水平正常（<400个细胞/μL）两组。对患者的资源使用情况进行随访，资源使用定义为住院、急诊就诊和门诊就诊，并计算相关费用，以评估嗜酸性粒细胞组之间是否存在经济差异。使用非参数检验比较嗜酸性粒细胞升高组和正常组之间的资源使用和相关成本。进行多变量建模以评估嗜酸性粒细胞水平对重度哮喘患者研究结果可能性的影响。
结果
在符合资格标准的2164名患者中，有1144名有严重程度的分类。其中，179名（16%）患者患有重度哮喘，其中20%（n = 35）嗜酸性粒细胞升高。在随访期间，嗜酸性粒细胞升高的患者中有17%住院，显著高于嗜酸性粒细胞水平正常的患者（12%；p = 0.011）。总体而言，与嗜酸性粒细胞水平正常的患者（n = 1734）相比，嗜酸性粒细胞升高的患者（n = 430）的平均年度住院次数（0.51次/年对0.21次/年，p = 0.006）和住院费用（2536美元对1091美元，p = 0.011）显著更高。逻辑回归显示，嗜酸性粒细胞水平升高与全因住院几率增加5.14倍相关（95%CI：1.76 - 14.99，p = 0.003），与哮喘相关住院几率增加4.07倍相关（95%CI：1.26 - 13.12，p = 0.019）。
结论
嗜酸性粒细胞升高与哮喘患者更多的医疗资源使用相关。
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