Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2021 Mar 26;16:795-806. doi: 10.2147/COPD.S294968. eCollection 2021.
Readmission after hospital discharge is common among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Predictive biomarkers of readmission would facilitate stratification strategies and individualized prognosis. Therefore, this study aimed to investigate the utility of type 2 biomarkers (eosinophils, periostin, and YKL-40) and a type 1 biomarker (CXCL9) in predicting readmission events in patients with AECOPD.
This is a prospective observational study design. Blood levels of eosinophils, periostin, YKL-40, and CXCL9 were measured at admission. The clinical outcomes were 12-month COPD-related readmission, time to COPD-related readmission, and number of 12-month COPD-related readmissions. These outcomes were analyzed using logistic and Cox regression models and Spearman's rank test.
A total of 123 patients were included, of whom 51 had experienced at least one readmission for AECOPD. High levels of eosinophils (≥200 cells/μL or 2% of the total white blood cell count, adjusted odds ratio [aOR] =3.138, =0.009) and YKL-40 (≥14.5 ng/mL, aOR =2.840, =0.015), as well as low CXCL9 levels (≤30.1 ng/mL, aOR =2.551, =0.028), were associated with an increased COPD-related readmission. The highest relative readmission rate was observed in patients with both high eosinophil and YKL-40 levels. Moreover, high eosinophil and YKL-40 levels were associated with a shorter time to first COPD-related readmission and an increased number of 12-month COPD-related readmissions.
High blood eosinophil and YKL-40 levels, as well as low CXCL9 levels, have predictive utility for the 12-month COPD-related readmission rate. Using eosinophils and YKL-40 together allows more precise identification of patients at high risk of COPD-related readmission.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）患者出院后再入院较为常见。预测再入院的生物标志物将有助于分层策略和个体化预后。因此，本研究旨在探讨 2 型生物标志物（嗜酸性粒细胞、骨膜蛋白和 YKL-40）和 1 型生物标志物（CXCL9）在预测 AECOPD 患者再入院事件中的作用。
这是一项前瞻性观察性研究设计。入院时测量嗜酸性粒细胞、骨膜蛋白、YKL-40 和 CXCL9 的血液水平。临床结局为 12 个月内与 COPD 相关的再入院、与 COPD 相关的再入院时间和 12 个月内与 COPD 相关的再入院次数。使用逻辑回归和 Cox 回归模型和 Spearman 秩检验分析这些结果。
共纳入 123 例患者，其中 51 例至少发生过一次 AECOPD 再入院。高水平的嗜酸性粒细胞（≥200 个细胞/μL 或总白细胞计数的 2%，调整后的优势比[aOR] =3.138，=0.009）和 YKL-40（≥14.5ng/mL，aOR=2.840，=0.015），以及低 CXCL9 水平（≤30.1ng/mL，aOR=2.551，=0.028）与增加 COPD 相关的再入院有关。在同时具有高嗜酸性粒细胞和 YKL-40 水平的患者中，相对再入院率最高。此外，高水平的嗜酸性粒细胞和 YKL-40 与首次 COPD 相关再入院时间缩短和 12 个月内 COPD 相关再入院次数增加有关。
血液嗜酸性粒细胞和 YKL-40 水平升高，以及 CXCL9 水平降低，对 12 个月内 COPD 相关再入院率具有预测作用。联合使用嗜酸性粒细胞和 YKL-40 可以更准确地识别 COPD 相关再入院风险较高的患者。
