Abstract
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−1 increase). BEC increases of ≥200 cells·µL−1 from exacerbation-free periods to exacerbations were associated with least hospitalisation risk (HR=0.32; 95% CI: 0.15–0.71) versus 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.
Abstract
Patients who have greater blood eosinophil counts during #AECOPD in the last year have lesser hospitalisation risk, enhanced OCS response and better response to OCS upon hospitalisation, as reflected by reduced readmissions https://bit.ly/2ZQIV1n
Footnotes
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Data sharing statement: Data underlying the findings described in this manuscript may be requested in accordance with AstraZeneca's data sharing policy described at https://www.astrazenecagroup-dt.pharmacm.com/DT/Home.
Conflict of interest: M. Kerkhof reports personal fees from the Observational and Pragmatic Research Institute outside the submitted work.
Conflict of interest: I. Chaudry reports personal fees from the Observational and Pragmatic Research Institute outside the submitted work.
Conflict of interest: I.D. Pavord reports personal fees and nonfinancial support from AstraZeneca and Boehringer Ingelheim, personal fees from Aerocrine, Almirall and Novartis, personal fees and nonfinancial support from GSK, personal fees from Genentech, Regeneron, MSD, Schering-Plough and Dey, and personal fees and nonfinancial support from Napp and from Respivert, outside the submitted work.
Conflict of interest: M. Miravitlles reports personal fees from AstraZeneca, Bial, Boehringer Ingelheim, Chiesi, Cipla and CSL Behring, grants and personal fees from Grifols, personal fees from Menarini, Novartis, Rovi, Sandoz, Zambon, Ferrer, Gebro Pharma, grants and personal fees from GlaxoSmithKline, and personal fees from Laboratorios Esteve, Mereo Biopharma, Novartis, pH Pharma, Teva and Verona Pharma, outside the submitted work.
Conflict of interest: C. Kook Rhee reports personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, GlaxoSmithKline, MSD, Mundipharma, Novartis, Takeda and Teva, outside the submitted work.
Conflict of interest: D.M.G. Halpin reports personal fees from AstraZeneca, personal fees and nonfinancial support from Boehringer Ingelheim, personal fees from Chiesi, CSL Behring and GlaxoSmithKline, personal fees and nonfinancial support from Novartis, and personal fees from Pfizer and Sanofi, outside the submitted work.
Conflict of interest: O.S. Usmani reports personal fees and other support from Boehringer Ingelheim, Chiesi, Edmond Pharma, GlaxoSmithKline and Mundipharma International, and personal fees from AstraZeneca, Cipla, NAPP, Novartis, Pearl Therapeutics, Roche, Sandoz, Takeda, Trudell Medical, UCB and Vectura, outside the submitted work.
Conflict of interest: R. Jones reports grants and personal fees from AstraZeneca and GSK, and personal fees from Boehringer Ingelheim, Chiesi, Novartis, Nutiricia and Pfizer, outside the submitted work.
Conflict of interest: J. Kocks reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Chiesi, grants and personal fees from GSK and Novartis, and grants from Mundi Pharma and TEVA, outside the submitted work.
Conflict of interest: M. Alacqua reports personal fees from AstraZeneca outside the submitted work.
Conflict of interest: T. Morris reports personal fees from AstraZeneca outside the submitted work.
Conflict of interest: A. Kaplan has nothing to disclose.
Conflict of interest: D.B. Price reports personal fees from the Observational and Pragmatic Research Institute outside the submitted work.
Support statement: This study was funded by AstraZeneca. Editorial support was provided by Joanne M. Faysal and Jennie G. Jacobson of JK Associates, Inc., and Michael A. Nissen of AstraZeneca. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 15, 2020.
- Accepted August 28, 2020.
- Copyright ©ERS 2020
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