Association between blood eosinophil count with asthma hospital readmissions

Barcala, Francisco Javier González; San-Jose, Maria-Esther; Nieto‐Fontarigo, Juan José; Carreira, José M.; Calvo-Álvarez, Uxío; Cruz, María Jesús; Facal, David; García-Sanz, María-Teresa; Valdés-Cuadrado, Luís; Salgado, Francisco-Javier

doi:10.1016/j.ejim.2018.02.034

Cited by 15 publications

(20 citation statements)

References 30 publications

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“…None of these studies, nor others examining readmissions after 30 days [ 27 – 29 ], examined the association of hospital readmissions with blood eosinophil count. While Gonzalez-Barcala et al [ 13 ] in their retrospective study at a single hospital in Spain found differently from the present study that elevated eosinophil count was associated with a lower incidence of readmissions, it is difficult to compare their study with ours because of differences in methods. For example, the reference blood eosinophil count was that taken upon admission rather than before hospitalization during a baseline year, and the length of the follow-up period for analyzing readmissions is unclear [ 13 ].…”

Section: Discussioncontrasting

confidence: 86%

“…Several demographic and socioeconomic risk factors for hospital readmissions have been reported for patients with asthma, including older age, greater number of comorbidities, an urban hospital setting, and longer length of hospital stay [ 11 , 12 ]. A recent study found that elevated blood eosinophil count (≥0.3x10 9 cells/L) in the first blood sample upon hospitalization was associated with a lower incidence of hospital readmissions as compared with an eosinophil count <0.3x10 9 cells/L [ 13 ]. Conversely, for patients with chronic obstructive pulmonary disease (COPD), a recent publication reports an association of increased readmissions with blood eosinophil count ≥0.20x10 9 cells/L at first hospitalization [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundRecent studies have demonstrated an association between high blood eosinophil counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood eosinophil count documented before the first hospitalization.MethodsThis historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood eosinophil count within 1 baseline year before admission. We analyzed the association between high blood eosinophil count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection.ResultsWe identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood eosinophil count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood eosinophil count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997).ConclusionsA high blood eosinophil count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood eosinophil count require careful follow-up, with treatment optimization, after discharge.

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Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…The relationship between blood eosinophil counts and hospitalization rate has been thoroughly investigated in recent years, with some studies [18, 33] showing elevated blood eosinophil counts associated to a higher exacerbation rate, while others report conflicting observations [34, 35]. Indeed, diverging results are also seen in terms of blood eosinophil counts and their association to hospital readmission [19, 36].…”

Section: Discussionmentioning

confidence: 99%

“…For blood eosinophil counts, cut-offs were arbitrarily defined as low eosinophils (< 150 cells/μL, n = 452), medium eosinophils (150–300 cells/μL, n = 237), and high eosinophils (> 300 cells/μL, n = 334) [13, 18, 19].…”

Section: Methodsmentioning

confidence: 99%

The biomarkers suPAR and blood eosinophils are associated with hospital readmissions and mortality in asthma – a retrospective cohort study

et al. 2019

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IntroductionPrognostic biomarkers in asthma are needed. The biomarker soluble urokinase plasminogen activator receptor (suPAR) has been associated with asthma control and with prognosis in acutely admitted medical patients. We investigated if suPAR and blood eosinophil counts at the time of admission for asthma are associated with readmission and mortality.MethodsOur cohort comprised 1341 patients (median age 45.3, IQR 30.1–63.1) acutely admitted with a diagnosis of asthma to Hvidovre Hospital, Denmark (November 2013 to March 2017). Patients had suPAR and blood eosinophils measured at admission. Outcomes were 365-day readmission and all-cause mortality. Logistic regression analysis adjusted for age, sex, C-reactive protein, and Charlson comorbidity score was used to assess the association of the two biomarkers with readmission and all-cause mortality.ResultsCompared to event-free patients, patients who were either readmitted (n = 452, 42.3%) or died (n = 57, 5.3%) had significantly higher suPAR concentrations (p < 0.0001) and lower eosinophil counts (p = 0.0031) at admission. The highest odds of readmission or mortality were observed for patients in either the 4th suPAR quartile (p < 0.0001) or with eosinophil counts < 150 cells/μL at admission. Increasing levels of suPAR were associated with 365-day readmission (OR 1.3 [1.0–1.6]; p = 0.05) and mortality (OR 2.9 [1.7–5.1]; p = 0.0002). Eosinophil count > 300 cells/μL was significantly associated with lower odds of readmission (OR 0.64 [0.5–0.9]; p = 0.005) and lower mortality (OR 0.7 [0.6–0.9]; p = 0.0007).ConclusionsIn patients acutely admitted with asthma, elevated suPAR concentrations together with blood eosinophil count < 150 cells/μL at the time of hospital admission were associated with both 365-day all-cause readmission and mortality.

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“…30 A study of 1316 patients admitted with non-life threatening exacerbations reported that an eosinophil count of ≥0.4 × 10 9 cells/L was associated with a reduction in late Step 5 readmission risk of 41% and a decrease in frequent late readmission of 63%. 31 An important limitation in many of these studies is the arbitrary selection of eosinophil count thresholds which were presumably extrapolated from studies evaluating blood eosinophil count as a pharmacodynamic biomarker of response to biologics, for example, ≥0.150 or 0.300 × 10 9 /L for mepolizumab, ≥0.300 × 10 9 /L for benralizumab and ≥0.400 × 10 9 /L for reslizumab. 9,10,32 However, it cannot simply be assumed that thresholds for pharmacodynamic re- 35,36 and eosinophilic respiratory exacerbations portend a higher likelihood of subsequent eosinophilic exacerbation.…”

Section: Discussionmentioning

confidence: 99%

Blood eosinophil count correlates with severity of respiratory failure in life‐threatening asthma and predicts risk of subsequent exacerbations

Yii

Tay

Puah

et al. 2019

Clin Experimental Allergy

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Background An elevated blood eosinophil count when asthma is stable predicts exacerbations and therapeutic response to corticosteroids or biologics targeting eosinophils. Few studies have examined the prognostic value of blood eosinophils measured at exacerbation. Aim To elucidate the relationship between a spot blood eosinophil count–measured at the onset of a life‐threatening asthma exacerbation–with indices of exacerbation severity and risk of subsequent exacerbations. Methods Real‐world, retrospective review of all life‐threatening asthma cases admitted at 4 public hospitals in Singapore between 2011‐2015. We assessed the trends and correlations between blood eosinophil count on admission with arterial blood gas values, duration of mechanical ventilation, and risk of death, hypoxic ischemic encephalopathy or respiratory arrest. Risk of future exacerbations among survivors was modelled using Cox regression and survival curves. Results There were 376 index life‐threatening exacerbations with median blood eosinophil count (5‐95th percentiles) of 0.270 × 109/L (0‐1.410 × 109/L). Arterial pH decreased and PCO2 increased with increasing eosinophil count. Duration of mechanical ventilation and risk of death, hypoxic ischaemic encephalopathy or respiratory arrest did not vary with eosinophils. Among 329 survivors who were followed‐up over a median of 52 months, blood eosinophils ≥1.200 × 109/L was associated with an increased hazard of emergency visits and/or admissions for asthma (hazard ratio 1.8, 95% confidence interval 1.1‐2.9, P = .02). Conclusion In this study of life‐threatening asthma, we found that a spot blood eosinophil count correlates with severity of respiratory failure and predicts risk of subsequent exacerbations.

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Association between blood eosinophil count with asthma hospital readmissions

Cited by 15 publications

References 30 publications

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

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

The biomarkers suPAR and blood eosinophils are associated with hospital readmissions and mortality in asthma – a retrospective cohort study

Blood eosinophil count correlates with severity of respiratory failure in life‐threatening asthma and predicts risk of subsequent exacerbations

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