Association between blood eosinophil count and risk of readmission for patients with asthma

Historical cohort study

Marjan Kerkhof, Trung N. Tran, Maarten van den Berge, Guy G. Brusselle, Gokul Gopalan, Rupert C. M. Jones, Janwillem W. H. Kocks, Andrew Menzies-Gow, Javier Nuevo, Ian D. Pavord, Sarang Rastogi, David B. Price

Research output: Contribution to journalArticle

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Abstract

Background Recent 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. Methods This 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. Results We 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). Conclusions A 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.
Original languageEnglish
Article numbere0201143
Pages (from-to)1-15
Number of pages15
JournalPloS ONE
Volume13
Issue number7
DOIs
Publication statusPublished - 25 Jul 2018

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Patient Readmission
asthma
eosinophils
cohort studies
Eosinophils
Blood
Cohort Studies
Asthma
blood
Hazards
Hospitalization
England
Medical Records
statistics
Cell Count
Statistics

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Kerkhof, M., Tran, T. N., van den Berge, M., Brusselle, G. G., Gopalan, G., Jones, R. C. M., ... Price, D. B. (2018). Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study. PloS ONE, 13(7), 1-15. [e0201143]. https://doi.org/10.1371/journal.pone.0201143

Association between blood eosinophil count and risk of readmission for patients with asthma : Historical cohort study. / Kerkhof, Marjan; Tran, Trung N.; van den Berge, Maarten; Brusselle, Guy G.; Gopalan, Gokul; Jones, Rupert C. M.; Kocks, Janwillem W. H.; Menzies-Gow, Andrew; Nuevo, Javier; Pavord, Ian D.; Rastogi, Sarang; Price, David B.

In: PloS ONE, Vol. 13, No. 7, e0201143, 25.07.2018, p. 1-15.

Research output: Contribution to journalArticle

Kerkhof, M, Tran, TN, van den Berge, M, Brusselle, GG, Gopalan, G, Jones, RCM, Kocks, JWH, Menzies-Gow, A, Nuevo, J, Pavord, ID, Rastogi, S & Price, DB 2018, 'Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study', PloS ONE, vol. 13, no. 7, e0201143, pp. 1-15. https://doi.org/10.1371/journal.pone.0201143
Kerkhof M, Tran TN, van den Berge M, Brusselle GG, Gopalan G, Jones RCM et al. Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study. PloS ONE. 2018 Jul 25;13(7):1-15. e0201143. https://doi.org/10.1371/journal.pone.0201143
Kerkhof, Marjan ; Tran, Trung N. ; van den Berge, Maarten ; Brusselle, Guy G. ; Gopalan, Gokul ; Jones, Rupert C. M. ; Kocks, Janwillem W. H. ; Menzies-Gow, Andrew ; Nuevo, Javier ; Pavord, Ian D. ; Rastogi, Sarang ; Price, David B. / Association between blood eosinophil count and risk of readmission for patients with asthma : Historical cohort study. In: PloS ONE. 2018 ; Vol. 13, No. 7. pp. 1-15.
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abstract = "Background Recent 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. Methods This 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. Results We 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). Conclusions A 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.",
author = "Marjan Kerkhof and Tran, {Trung N.} and {van den Berge}, Maarten and Brusselle, {Guy G.} and Gokul Gopalan and Jones, {Rupert C. M.} and Kocks, {Janwillem W. H.} and Andrew Menzies-Gow and Javier Nuevo and Pavord, {Ian D.} and Sarang Rastogi and Price, {David B.}",
note = "Funding: Data acquisition and analyses were funded by AstraZeneca. This was a collaborative study involving both employees of the sponsor and an independent steering committee. The funder of the study participated in the study design, decision to publish, and preparation of the manuscript. In addition, the funder provided support in the form of salaries for authors TNT, GG, JN, and SR. Employees of the sponsor were part of the study steering committee and participated in the study design. Writing and editorial support was funded by the Observational and Pragmatic Research Institute Pte Ltd (OPRI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",
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TY - JOUR

T1 - Association between blood eosinophil count and risk of readmission for patients with asthma

T2 - Historical cohort study

AU - Kerkhof, Marjan

AU - Tran, Trung N.

AU - van den Berge, Maarten

AU - Brusselle, Guy G.

AU - Gopalan, Gokul

AU - Jones, Rupert C. M.

AU - Kocks, Janwillem W. H.

AU - Menzies-Gow, Andrew

AU - Nuevo, Javier

AU - Pavord, Ian D.

AU - Rastogi, Sarang

AU - Price, David B.

N1 - Funding: Data acquisition and analyses were funded by AstraZeneca. This was a collaborative study involving both employees of the sponsor and an independent steering committee. The funder of the study participated in the study design, decision to publish, and preparation of the manuscript. In addition, the funder provided support in the form of salaries for authors TNT, GG, JN, and SR. Employees of the sponsor were part of the study steering committee and participated in the study design. Writing and editorial support was funded by the Observational and Pragmatic Research Institute Pte Ltd (OPRI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2018/7/25

Y1 - 2018/7/25

N2 - Background Recent 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. Methods This 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. Results We 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). Conclusions A 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.

AB - Background Recent 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. Methods This 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. Results We 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). Conclusions A 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.

U2 - 10.1371/journal.pone.0201143

DO - 10.1371/journal.pone.0201143

M3 - Article

VL - 13

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EP - 15

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

IS - 7

M1 - e0201143

ER -