Greater eosinophil counts at first COPD hospitalization are associated with more readmissions and fewer deaths

• Published in: International journal of chronic obstructive pulmonary disease 2019-01, Vol.14, p.331-341
• Main Authors: Li, Qing, Larivée, Pierre, Courteau, Josiane, Couillard, Simon, Poder, Thomas G, Carrier, Nathalie, Bélanger, Maryse, Vanasse, Alain
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Asthma; Blood; Blood cell count; Blood eosinophil cell count; Chronic illnesses; Chronic obstructive pulmonary disease; Cohort analysis; COPD; death; Disease Progression; Eosinophils; exacerbations; Female; Hospitalization; Humans; Investigations; Leukocyte Count; Lung diseases, Obstructive; Male; Markov Chains; Markov processes; Medical records; Middle Aged; multi-state Markov model; Observational studies; Original Research; Patient Admission; Patient Readmission; Patients; Pharmaceutical industry; Pneumonia; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - therapy; readmissions; Retrospective Studies; Risk Assessment; Risk Factors; Spirometry; Steroids; Time Factors; Variables
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S187375

The impacts of high blood eosinophil count (HBEC) at admission for COPD exacerbation on posthospitalization outcomes are still unclear. Previous studies have focused on its associations with first readmission rates; yet, its impacts on longitudinal outcomes such as subsequent readmissions still have to be explored. The main objective of this study is to investigate outcomes associated with HBEC following a first hospitalization for COPD exacerbation. This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the HBEC group if the blood eosinophil count at admission was ≥200 cells/µL and/or ≥2% of the total white blood cells. With information on exact dates of subsequent hospitalizations and death, we modeled readmissions and death as states in a multi-state Markov model and estimated transition probabilities to the next states. Sensitivity analyses were performed by varying thresholds for the definition of HBEC (≥300 cells/µL and/or ≥3%). A total of 479 patients were included, of which 173 had HBEC. The transition probabilities for a first readmission was 74% (95% CI, 66%-83%) for patients with HBEC vs 70% (95% CI, 63%-77%) for patients with normal blood eosinophil count (NBEC). The transition probabilities for a second readmission were 91% (95% CI, 84%-100%) for HBEC patients in contrast with 83% (95% CI, 74%-92%) for NBEC patients. Meanwhile, transition probability for death was lower in patients with HBEC. The differences enlarged in sensitivity analyses with higher cutoff. Greater blood eosinophil cell counts during a first hospitalization for COPD predict increased susceptibility to up to two readmissions. These patients may however have a lower risk of death.