期刊
CHEST
卷 150, 期 2, 页码 320-328出版社
AMER COLL CHEST PHYSICIANS
DOI: 10.1016/j.chest.2016.01.026
关键词
C-reactive protein; COPD; eosinophils; exacerbations; hospitalizations; treatment
资金
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care in Leicestershire, Northamptonshire, and Rutland
- NIHR Post-Doctoral Fellowship
- NIHR Leicester Respiratory Biomedical Research Unit and Collaboration for Leadership in Applied Health Research and Care in East Midlands
- University of Leicester Clinical Trials Unit
- Medical Research Council [G0601369] Funding Source: researchfish
- National Institute for Health Research [PDF-2013-06-052, NF-SI-0512-10018] Funding Source: researchfish
- MRC [G0601369] Funding Source: UKRI
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/mu L 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/mu L (range, 10-1,500 cells/mu L), 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.
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