Kerkhof Marjan, Chaudhry Isha, Pavord Ian D, Miravitlles Marc, Kook Rhee Chin, Halpin David M G, Usmani Omar S, Jones Rupert, Kocks Janwillem, Alacqua Marianna, Morris Tamsin, Kaplan Alan, Price David B
Observational and Pragmatic Research Institute, Singapore, Singapore.
Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.
ERJ Open Res. 2020 Nov 10;6(4). doi: 10.1183/23120541.00188-2020. eCollection 2020 Oct.
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 increase). BEC increases of ≥200 cells·µL from exacerbation-free periods to exacerbations were associated with least hospitalisation risk (HR=0.32; 95% CI: 0.15-0.71) 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.
我们研究了急性口服糖皮质激素（OCS）治疗慢性阻塞性肺疾病（COPD）加重期后，血嗜酸性粒细胞计数（BEC）与治疗失败或再次入院风险之间的关联。我们利用最佳患者护理研究数据库（OPCRD）（www.optimumpatientcare.org/opcrd）和临床实践研究数据链（CPRD）（www.cprd.com/home/）开展研究，这两个数据库均为经过验证的医学研究数据库，并与约20000名年龄≥40岁的COPD患者的医院事件统计（HES）数据相链接。对于在初级保健中接受OCS治疗COPD加重期且在OCS治疗首日记录了BEC的患者（队列1），我们评估了治疗失败情况（与COPD相关的住院治疗以及超出首次OCS疗程的OCS处方）。对于因COPD加重期住院且在入院前一年无加重期期间测量了BEC的患者（队列2），我们评估了再入院率。采用Cox比例风险回归分析对混杂因素进行校正，以估计BEC与治疗结局之间的关联。在初级保健中接受OCS治疗COPD加重期的患者（队列1）中，44%的患者在单次OCS疗程后出现治疗失败，10%（255/2482）的患者住院时间≤6周。较高的BEC与降低的住院风险相关（风险比[HR]=0.26；95%置信区间：0.12 - 0.56，每增加100个细胞·µL）。从无加重期到加重期BEC增加≥200个细胞·µL与最低的住院风险相关（HR=0.32；95%置信区间：0.15 - 0.71），而BEC无变化时则不然。对于因COPD加重期住院的患者（队列2），4周内的再入院率为12%（1189/10245）。过去一年无加重期期间BEC增加与短期再入院风险降低相关（HR=0.78；95%置信区间：0.63 - 0.96）。较高的BEC预示着接受OCS治疗的COPD加重期患者无论在社区管理还是医院管理下都有更好的结局。嗜酸性粒细胞减少预示着更差的结局。
