Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Int J Chron Obstruct Pulmon Dis. 2020 Apr 5;15:733-743. doi: 10.2147/COPD.S229904. eCollection 2020.
The biomarker soluble urokinase plasminogen activator receptor (suPAR) has been associated with increased mortality in chronic obstructive pulmonary disease (COPD), while elevated blood eosinophils have been associated with better survival. We hypothesized that suPAR and blood eosinophil count are independent risk factors for readmission and mortality after an acute admission in patients with COPD.
This retrospective cohort study comprised 4022 patients with prevalent COPD acutely admitted to Hvidovre Hospital, Denmark. Irrespective of cause of admission, suPAR and blood eosinophils were measured, and patients were followed up to 365 days. Associations with 365-day respiratory readmission, all-cause readmission and all-cause mortality were investigated by Cox regression analyses adjusted for age, sex, Charlson score and C-reactive protein.
suPAR was significantly elevated in patients who later experienced readmission or died. At 365 days, hazard ratios (HRs) for all-cause readmission and mortality reached 1.61 (95% CI 1.40-1.85; p<0.0001) and 3.40 (95% CI 2.64-4.39; p<0.0001), respectively, for COPD patients in the fourth suPAR quartile compared to patients in the first suPAR quartile. High blood eosinophils (>300 cells/μL) were associated with lower risk of mortality (HR 0.49, 95% CI 0.39-0.62; p<0.0001) compared with patients with <150 cells/μL. When stratifying patients by suPAR quartiles and blood eosinophil counts, the highest relative mortality rate was found in patients belonging to both the fourth suPAR quartile and the low blood eosinophil (<150 cells/μL) group.
In this cohort of COPD patients acutely admitted to a hospital, elevated suPAR concentrations were associated with both higher risk of all-cause readmission and mortality, whereas higher blood eosinophil count was associated with lower risk of mortality.
生物标志物可溶性尿激酶型纤溶酶原激活物受体（suPAR）与慢性阻塞性肺疾病（COPD）患者的死亡率增加相关，而血液嗜酸性粒细胞升高与更好的生存相关。我们假设 suPAR 和血液嗜酸性粒细胞计数是 COPD 患者急性入院后再入院和死亡的独立危险因素。
本回顾性队列研究纳入了丹麦 Hvidovre 医院收治的 4022 例 COPD 患者。无论入院原因如何，均测量了 suPAR 和血液嗜酸性粒细胞，并对患者进行了 365 天的随访。通过 Cox 回归分析，调整年龄、性别、Charlson 评分和 C 反应蛋白后，评估了 365 天内呼吸再入院、全因再入院和全因死亡率与 suPAR 和血液嗜酸性粒细胞的相关性。
suPAR 在随后经历再入院或死亡的患者中显著升高。在 365 天时，第 4 四分位 suPAR 组患者的全因再入院和死亡率的危险比（HR）分别达到 1.61（95%CI 1.40-1.85；p<0.0001）和 3.40（95%CI 2.64-4.39；p<0.0001），而第 1 四分位 suPAR 组患者的相应 HR 分别为 1.00。高血液嗜酸性粒细胞（>300 细胞/μL）与较低的死亡率相关（HR 0.49，95%CI 0.39-0.62；p<0.0001），而与血液嗜酸性粒细胞<150 细胞/μL 的患者相比。当按 suPAR 四分位数和血液嗜酸性粒细胞计数分层患者时，发现属于第四 suPAR 四分位数和低血液嗜酸性粒细胞（<150 细胞/μL）组的患者的相对死亡率最高。
在本队列中，急性入住医院的 COPD 患者中，suPAR 浓度升高与全因再入院和死亡率的风险增加相关，而血液嗜酸性粒细胞计数升高与死亡率降低相关。
