Pulmonary and Critical Care Medicine Division, Intermountain Medical Center, Murray, UT, USA.
Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.
Int J Chron Obstruct Pulmon Dis. 2020 Oct 23;15:2629-2641. doi: 10.2147/COPD.S251115. eCollection 2020.
This retrospective, observational cohort study investigated the association of blood eosinophil counts within 1 week of hospitalization for acute exacerbation of COPD (AECOPD) with subsequent risk of all-cause and COPD-related readmission from a large integrated health system.
Electronic medical records were extracted for index hospitalization for AECOPD at all Intermountain Healthcare hospitals. The primary outcome was the relationship of blood eosinophil count to 30-day all-cause readmission; secondary outcomes were 60-day, 90-day, and 12-month all-cause readmission, COPD-related readmission, and empiric derivation of the eosinophil count with the highest area under the curve (AUC) for predicting 30-day all-cause readmission.
Of 2445 included patients, 1935 (79%) had a blood eosinophil count <300 cells/µL and 510 (21%) had a count ≥300 cells/µL. Using a 300-cells/μL threshold, there was no significant difference between high and low eosinophil groups in 30-day (odds ratio [OR]=1.05, 95% confidence interval [CI]=0.75-1.47) or 60-day (OR=1.15, 95% CI=0.88-1.51) all-cause readmissions. However, patients with greater (versus lesser) eosinophil counts had increased 90-day and 12-month all-cause readmissions (OR=1.35, 95% CI=1.06-1.72, and OR=1.32, 95% CI=1.07-1.62). COPD-related readmission rates were significantly greater for patients with greater (versus lesser) eosinophil counts at 30, 60, and 90 days and 12 months (OR range=1.52-1.97). A total of 70 cells/µL had the most discriminatory power to predict 30-day all-cause readmission (highest AUC).
Eosinophil counts in patients with COPD were not associated with a difference in 30-day all-cause readmissions. However, greater eosinophil counts were associated with increased risk of all-cause readmission at 90 days and 12 months and COPD-related readmission at 30, 60, and 90 days and 12 months. Patients with eosinophils <70 cells/μL had the lowest risk for 30-day all-cause readmission. Blood eosinophils in patients hospitalized with AECOPD may be a useful biomarker for the risk of hospital readmission.
本回顾性观察队列研究调查了急性加重期 COPD（AECOPD）住院后 1 周内的血液嗜酸性粒细胞计数与来自大型综合医疗系统的全因和 COPD 相关再入院风险之间的关联。
从 Intermountain Healthcare 医院的所有医院提取 AECOPD 索引住院的电子病历。主要结局是血液嗜酸性粒细胞计数与 30 天全因再入院的关系；次要结局是 60 天、90 天和 12 个月全因再入院、与 COPD 相关的再入院以及预测 30 天全因再入院的最高曲线下面积（AUC）的嗜酸性粒细胞计数的经验推导。
在 2445 名纳入的患者中，1935 名（79%）的血液嗜酸性粒细胞计数<300 个/µL，510 名（21%）的计数≥300 个/µL。使用 300 个/μL 的阈值，高嗜酸性粒细胞组和低嗜酸性粒细胞组在 30 天（比值比 [OR]=1.05，95%置信区间 [CI]=0.75-1.47）或 60 天（OR=1.15，95% CI=0.88-1.51）全因再入院方面无显著差异。然而，与嗜酸性粒细胞计数较少的患者相比，嗜酸性粒细胞计数较多的患者在 90 天和 12 个月的全因再入院率更高（OR=1.35，95% CI=1.06-1.72 和 OR=1.32，95% CI=1.07-1.62）。与嗜酸性粒细胞计数较少的患者相比，30、60 和 90 天和 12 个月时，与 COPD 相关的再入院率显著更高（OR 范围=1.52-1.97）。70 个/µL 的嗜酸性粒细胞总数具有预测 30 天全因再入院的最高鉴别能力（最高 AUC）。
COPD 患者的嗜酸性粒细胞计数与 30 天全因再入院率无差异。然而，较高的嗜酸性粒细胞计数与 90 天和 12 个月的全因再入院风险以及 30、60 和 90 天和 12 个月的与 COPD 相关的再入院风险增加相关。嗜酸性粒细胞<70 个/µL 的患者 30 天全因再入院风险最低。AECOPD 住院患者的血液嗜酸性粒细胞可能是预测医院再入院风险的有用生物标志物。
