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Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD

Bafadhel, Mona; Greening, Neil J.; Harvey-Dunstan, Theresa C.; Williams, Johanna E.A.; Morgan, Michael D.; Brightling, Christopher E.; Hussain, Syed F.; Pavord, Ian D.; Singh, Sally J.; Steiner, Michael C.

Authors

Mona Bafadhel

Neil J. Greening

Theresa C. Harvey-Dunstan

Johanna E.A. Williams

Michael D. Morgan

Christopher E. Brightling

Syed F. Hussain

Ian D. Pavord

Sally J. Singh

Michael C. Steiner



Abstract

Background: Patients with moderate exacerbations of COPD and the eosinophilic phenotype have better outcomes with prednisolone. Whether this outcome is similar in patients hospitalized with a severe exacerbation of COPD is unclear. We investigated the rate of recovery of eosinophilic and noneosinophilic exacerbations in patients participating in a multicenter randomized controlled trial assessing health outcomes in hospitalized exacerbations.
Methods: Patients were recruited at presentation to the hospital with an exacerbation of COPD. They were stratified into groups according to eosinophilic exacerbations if the peripheral blood eosinophil count on admission was ≥ 200 cells/μL and/or ≥ 2% of the total leukocyte count. Admission details, serum C-reactive protein levels, length of stay, and subsequent rehospitalization data were compared between groups.
Results: A total of 243 patients with COPD (117 men) with a mean age of 71 years (range, 45-93 years) were recruited. The inpatient mortality rate was 3% (median time to death, 12 days; range, 9-16 days). The median absolute eosinophil count was 100 cells/μL (range, 10-1,500 cells/μL), and 25% met our criteria for an eosinophilic exacerbation; in this population, the mean length of stay (in days) was shorter than in patients with noneosinophilic exacerbations (5.0 [range, 1-19] vs 6.5 [range, 1-33]; P = .015) following treatment with oral corticosteroids and independent of treatment prior to admission. Readmission rates at 12 months were similar between groups.
Conclusions: The study patients presenting to the hospital with a severe eosinophilic exacerbation of COPD had a shorter length of stay. The exacerbations were usually not associated with elevated C-reactive protein levels, suggesting that better treatment stratification of exacerbations can be used.

Journal Article Type Article
Publication Date Aug 31, 2016
Journal Chest
Print ISSN 0012-3692
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 150
Issue 2
Pages 320-328
APA6 Citation Bafadhel, M., Greening, N. J., Harvey-Dunstan, T. C., Williams, J. E., Morgan, M. D., Brightling, C. E., …Steiner, M. C. (2016). Blood eosinophils and outcomes in severe hospitalized exacerbations of COPD. Chest, 150(2), 320-328. doi:10.1016/j.chest.2016.01.026
DOI https://doi.org/10.1016/j.chest.2016.01.026
Keywords Critical Care and Intensive Care Medicine; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine
Publisher URL https://www.sciencedirect.com/science/article/pii/S001236921600581X?via%3Dihub
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