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S46 Blood eosinophil counts and risk of short-term hospital readmission for COPD exacerbation
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  1. M Kerkhof1,
  2. S Rastogi2,
  3. M Alacqua3,
  4. R Jones4,
  5. CK Rhee5,
  6. M Miravitlles6,
  7. I Pavord7,
  8. D Price1,8
  1. 1Observational and Pragmatic Research Institute, Singapore
  2. 2AstraZeneca, Gaithersburg, MD, USA
  3. 3AstraZeneca, Luton, UK
  4. 4The Peninsula College of Medicine and Dentistry, Plymouth, UK
  5. 5College of Medicine, Seoul St Mary’s Hospital/The Catholic University of Korea, Seoul, South Korea
  6. 6Hospital Universitari Vall d’Hebron, Barcelona, Spain
  7. 7NIHR Respiratory BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  8. 8Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

Abstract

Introduction and objectives Elevated blood eosinophil count (BEC) is a proposed biomarker for risk of readmission for patients with COPD. We aimed to determine if preadmission BEC is an indicator of short-term hospital readmission for COPD exacerbation.

Methods We analyzed 2 years of medical records data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage historic database) from patients hospitalized for COPD exacerbation (ICD-10 codes J44.0 or J44.1). Patients were included if they had a BEC recorded during stable disease (no exacerbation 4 weeks prior to measurement) within 1 year prior to hospitalization discharge (index date). We analyzed the association between BEC and readmission risk within 4 weeks after index date, with adjustment for age, sex, smoking status, body mass index, and timing of BEC by Cox regression. We also assessed independent clinical predictors of short-term hospital readmission.

Results Of 10 246 patients who met the inclusion criteria, 11.6% (n=1,189) were readmitted to hospital for COPD exacerbation within 4 weeks of discharge. Patients with very high BEC (≥0.65×109/L; 5.1%) had the lowest risk (figure 1), which was most accentuated in 53% of patients treated with oral corticosteroids in general practice in the baseline year (hazard ratio [95% confidence interval]=0.53 [0.34–0.81]). A very low BEC (<0.05×109/L) was a significant independent risk factor of short-term readmission, in addition to older age, male sex, being underweight, treatment with triple therapy, a greater number of baseline exacerbations, greater degree of dyspnea (modified Medical Research Council dyspnea scale score), lesser% predicted forced expiratory volume in 1 s, and a diagnosis of anxiety or depression.

Abstract 46 Figure 1

Short-term readmission for COPD exacerbations within 4 weeks

Conclusions Patients with BEC ≥0.65 × 109/L measured during stable disease state were at reduced risk of short-term readmission for COPD exacerbation, whereas those with eosinopenia were at increased risk, perhaps indicating poor treatment response. Clinical features beyond blood eosinophils may help identifying patients at risk of hospital readmission.

Please refer to page A265 for declarations of interest related to this abstract.

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