TY - JOUR T1 - Blood Eosinophil Count Predicts Treatment Failure and Hospital Readmission for COPD JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00188-2020 SP - 00188-2020 AU - Marjan Kerkhof AU - Isha Chaudhry AU - Ian D. Pavord AU - Marc Miravitlles AU - Chin Kook Rhee AU - David M.G. Halpin AU - Omar S. Usmani AU - Rupert Jones AU - Janwillem Kocks AU - Marianna Alacqua AU - Tamsin Morris AU - Alan Kaplan AU - David B. Price Y1 - 2020/01/01 UR - http://openres.ersjournals.com/content/early/2020/09/17/23120541.00188-2020.abstract N2 - 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 OPCRD (www.optimumpatientcare.org/opcrd) and 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 BEC 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 during an exacerbation-free period during year prior to admission (Cohort 2), we assessed readmission rate. Cox proportional hazards regression analysis adjusted for confounders to estimate 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 ≤6 weeks. Greater BEC was associated with reduced hospital-admission risk (hazard ratio [HR]=0.26 [95% confidence interval [CI]: 0.12, 0.56] per 100-cells·µL−1 increase). BEC increases ≥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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Kerkhof reports personal fees from Observational and Pragmatic Research Institute, outside the submitted work;.Conflict of interest: Dr. Chaudry reports personal fees from Observational and Pragmatic Research Institute, outside the submitted work;.Conflict of interest: Dr. Pavord reports personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Inglehiem, personal fees from Aerocrine, personal fees from Almirall, personal fees from Novartis, personal fees and non-financial support from GSK, personal fees from Genentech, personal fees from Regeneron, personal fees from MSD, personal fees from Schering-Plough, personal fees from Dey, personal fees and non-financial support from Napp, from Respivert, outside the submitted work;.Conflict of interest: Dr. Miravitlles reports personal fees from AstraZeneca, personal fees from Bial, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from Cipla, personal fees from CSL Behring, grants and personal fees from Grifols, personal fees from Menarini, personal fees from Novartis, personal fees from Rovi, personal fees from Sandoz, personal fees from Zambon, personal fees from Ferrer, personal fees from Gebro Pharma, grants and personal fees from GlaxoSmithKline, personal fees from Laboratorios Esteve, personal fees from Mereo Biopharma, personal fees from Novartis, personal fees from pH Pharma, personal fees from Teva, personal fees from Verona Pharma, outside the submitted work;.Conflict of interest: Dr. Kook Rhee reports personal fees from AstraZeneca, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKline, personal fees from MSD, personal fees from Mundipharma, personal fees from Novartis, personal fees from Takeda, personal fees from Teva, outside the submitted work;.Conflict of interest: Dr. Halpin reports personal fees from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Chiesi, personal fees from CSL Behring, personal fees from GlaxoSmithKline, personal fees and non-financial support from Novartis, personal fees from Pfizer, personal fees from Sanofi, outside the submitted work;.Conflict of interest: Dr. Usmani reports personal fees and other from Boehringer Ingelheim, personal fees and other from Chiesi, personal fees and other from Edmond Pharma, personal fees and other from GlaxoSmithKline, personal fees and other from Mundipharma International, personal fees from AstraZeneca, personal fees from Cipla, personal fees from NAPP, personal fees from Novartis, personal fees from Pearl Therapeutics, personal fees from Roche, personal fees from Sandoz, personal fees from Takeda, personal fees from Trudell Medical, personal fees from UCB, personal fees from Vectura, outside the submitted work;.Conflict of interest: Dr. Jones reports grants and personal fees from AstraZeneca, grants and personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from Novartis, personal fees from Nutiricia, personal fees from Pfizer, outside the submitted work;.Conflict of interest: Dr. Kocks reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants from Chiesi, grants and personal fees from GSK, grants and personal fees from Novartis, grants from Mundi Pharma, grants from TEVA, outside the submitted work;.Conflict of interest: Dr. Alacqua reports personal fees from AstraZeneca, outside the submitted work;.Conflict of interest: Dr. Morris reports personal fees from AstraZeneca, outside the submitted work;.Conflict of interest: Dr. Kaplan has nothing to disclose.Conflict of interest: Dr. Price reports personal fees from Observational and Pragmatic Research Institute, outside the submitted work;. 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