Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

Kerkhof, Marjan; Tran, Trung; Berge, Maarten van den; Brusselle, Guy; Gopalan, Gokul; Jones, Rupert; Kocks, Janwillem; Menzies‐Gow, Andrew; Nuevo, Javier; Pavord, Ian; Rastogi, Sarang; Price, David

doi:10.1371/journal.pone.0201143

Cited by 37 publications

(31 citation statements)

References 32 publications

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“…Another marker evaluated in our study is FENO. This is a validated and specific biomarker for T2-driven airway inflammation in asthma and its use in the clinical assessment of asthma is recommended by Guidelines from the American Thoracic Society [28]. In our study, FENO levels are significantly higher in current asthma compared to controls as we expected.…”

Section: Discussionsupporting

confidence: 78%

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Biomarkers of Oxidative Stress and Inflammation in Chronic Airway Diseases

Chamitava

Cazzoletti

Ferrari

et al. 2020

IJMS

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Introduction: The global burden of chronic airway diseases represents an important public health concern. The role of oxidative stress and inflammation in the pathogenesis of these diseases is well known. The aim of this study is to evaluate the behavior of both inflammatory and oxidative stress biomarkers in patients with chronic bronchitis, current asthma and past asthma in the frame of a population-based study. Methods: For this purpose, data collected from the Gene Environment Interactions in Respiratory Diseases (GEIRD) Study, an Italian multicentre, multicase-control study, was evaluated. Cases and controls were identified through a two-stage screening process of individuals aged 20-65 years from the general population. Out of 16,569 subjects selected from the general population in the first stage of the survey, 2259 participated in the clinical evaluation. Oxidative stress biomarkers such as 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG), 8-isoprostane and glutathione and inflammatory biomarkers such as Fractional Exhaled Nitric Oxide (FENO) and white blood cells were evaluated in 1878 subjects. Results: Current asthmatics presented higher levels of FENO (23.05 ppm), leucocytes (6770 n/µL), basophils (30.75 n/µL) and eosinophils (177.80 n/µL), while subjects with chronic bronchitis showed higher levels of GSH (0.29 mg/mL) and lymphocytes (2101.6 n/µL). The multivariable multinomial logistic regression confirmed high levels of leucocytes (RRR = 1.33), basophils (RRR = 1.48), eosinophils (RRR = 2.39), lymphocytes (RRR = 1.26) and FENO (RRR = 1.42) in subjects with current asthma. Subjects with past asthma had a statistically significant higher level of eosinophils (RRR = 1.78) with respect to controls. Subjects with chronic bronchitis were characterized by increased levels of eosinophils (RRR = 2.15), lymphocytes (RRR = 1.58), GSH (RRR = 2.23) and 8-isoprostane (RRR = 1.23). Conclusion: In our study, current asthmatics show a greater expression of the inflammatory profile compared to subjects who have had asthma in the past and chronic bronchitis. On the other hand, chronic bronchitis subjects showed a higher rate of expression of oxidative stress biomarkers compared to asthmatic subjects. In particular, inflammatory markers such as circulating inflammatory cells and FENO seem to be more specific for current asthma, while oxidative stress biomarkers such as glutathione and 8-isoprostane appear to be more specific and applicable to patients with chronic bronchitis.

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Section: Discussionsupporting

confidence: 78%

“…Blood eosinophil count is an established biomarker in asthma. A high blood eosinophil count correlates with poor asthma control and with an increased risk of severe exacerbations and hospitalizations [26][27][28]. Another marker evaluated in our study is FENO.…”

Section: Discussionmentioning

confidence: 66%

Biomarkers of Oxidative Stress and Inflammation in Chronic Airway Diseases

Chamitava

Cazzoletti

Ferrari

et al. 2020

IJMS

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“…At the same time concomitant comorbidities, such as obesity or psychiatric conditions, may negatively affect the perception of the functional improvement due to the treatment. Higher eosinophil count has also been related to a more severe disease 11 , but the individual intrinsic variability of this parameter 12 has to be taken into account. Likewise, the effect on the quality-of-life is controversial 3 , being perhaps more relevant in allergic asthma.…”

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confidence: 99%

Uncontrolled severe asthma: starting from the unmet needs

Caminati

Senna

2018

Current Medical Research and Opinion

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“… 33 , 34 A recent historical cohort study investigated the relationship between high blood eosinophil counts (≥350 cells/µL) and hospital readmission in 2613 patients with asthma hospitalized for acute exacerbation. 35 Results showed that a high blood eosinophil count in the year before asthma-related hospitalization is associated with an increased risk of readmission within the following year. 35 A secondary diagnosis of asthma was present in 26% of the patient population with no difference between the high and low eosinophil groups.…”

Section: Limitationsmentioning

confidence: 97%

“… 35 Results showed that a high blood eosinophil count in the year before asthma-related hospitalization is associated with an increased risk of readmission within the following year. 35 A secondary diagnosis of asthma was present in 26% of the patient population with no difference between the high and low eosinophil groups. Among the subgroup of patients with COPD who had a secondary diagnosis of asthma, the association of blood eosinophil count with all-cause readmission in the univariable analysis was not significant, and patients with a secondary diagnosis of asthma had similar readmission rates compared to those without asthma.…”

Section: Limitationsmentioning

confidence: 97%

<p>Blood Eosinophil Count and Hospital Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

Hegewald

Horne

Trudo

et al. 2020

COPD

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Purpose This retrospective, observational cohort study investigated the association of blood eosinophil counts within 1 week of hospitalization for acute exacerbation of COPD (AECOPD) with subsequent risk of all-cause and COPD-related readmission from a large integrated health system. Patients and Methods Electronic medical records were extracted for index hospitalization for AECOPD at all Intermountain Healthcare hospitals. The primary outcome was the relationship of blood eosinophil count to 30-day all-cause readmission; secondary outcomes were 60-day, 90-day, and 12-month all-cause readmission, COPD-related readmission, and empiric derivation of the eosinophil count with the highest area under the curve (AUC) for predicting 30-day all-cause readmission. Results Of 2445 included patients, 1935 (79%) had a blood eosinophil count <300 cells/µL and 510 (21%) had a count ≥300 cells/µL. Using a 300-cells/μL threshold, there was no significant difference between high and low eosinophil groups in 30-day (odds ratio [OR]=1.05, 95% confidence interval [CI]=0.75–1.47) or 60-day (OR=1.15, 95% CI=0.88–1.51) all-cause readmissions. However, patients with greater (versus lesser) eosinophil counts had increased 90-day and 12-month all-cause readmissions (OR=1.35, 95% CI=1.06–1.72, and OR=1.32, 95% CI=1.07–1.62). COPD-related readmission rates were significantly greater for patients with greater (versus lesser) eosinophil counts at 30, 60, and 90 days and 12 months (OR range=1.52–1.97). A total of 70 cells/µL had the most discriminatory power to predict 30-day all-cause readmission (highest AUC). Conclusion Eosinophil counts in patients with COPD were not associated with a difference in 30-day all-cause readmissions. However, greater eosinophil counts were associated with increased risk of all-cause readmission at 90 days and 12 months and COPD-related readmission at 30, 60, and 90 days and 12 months. Patients with eosinophils <70 cells/μL had the lowest risk for 30-day all-cause readmission. Blood eosinophils in patients hospitalized with AECOPD may be a useful biomarker for the risk of hospital readmission.

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Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

Cited by 37 publications

References 32 publications

Biomarkers of Oxidative Stress and Inflammation in Chronic Airway Diseases

Biomarkers of Oxidative Stress and Inflammation in Chronic Airway Diseases

Uncontrolled severe asthma: starting from the unmet needs

<p>Blood Eosinophil Count and Hospital Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

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