title: Blood Eosinophils and Outcomes in Severe Hospitalized Exacerbations of COPD.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  http://www.isrctn.com/ISRCTN05557928.
authors: Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. Electronic address: mona.bafadhel@ndm.ox.ac.uk.
authors: Mona
authors: M
authors: Bafadhel
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK; NIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK.
authors: Neil J
authors: NJ
authors: Greening
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK; NIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK.
authors: Theresa C
authors: TC
authors: Harvey-Dunstan
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK.
authors: Johanna E A
authors: JE
authors: Williams
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK; NIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK.
authors: Michael D
authors: MD
authors: Morgan
authors: Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors: Christopher E
authors: CE
authors: Brightling
authors: Kettering General Hospital NHS Foundation Trust, Kettering, UK.
authors: Syed F
authors: SF
authors: Hussain
authors: Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
authors: Ian D
authors: ID
authors: Pavord
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK; NIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK.
authors: Sally J
authors: SJ
authors: Singh
authors: Centre for Exercise and Rehabilitation Science, University of Leicester NHS Hospitals Trust, Glenfield Hospital, Leicester, UK; NIHR Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
authors: Michael C
authors: MC
authors: Steiner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000276:immunology; D018450:Disease Progression; D004802:Eosinophilia / Q000453:epidemiology / Q000276:immunology*; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D000072896:Morgue; D010359:Patient Readmission; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012720:Severity of Illness Index; D014797:Vital Capacity
chemical_list: D000305:Adrenal Cortex Hormones; D002097:C-Reactive Protein
keywords: C-reactive protein; COPD; eosinophils; exacerbations; hospitalizations; treatment