Introduction

COPD exacerbation phenotypes have been defined in research populations by predominantly infective or inflammatory aetiology. We sought to characterise this in patients admitted to our centre.

Materials and methods

Case-notes of consecutive patients discharged alive after treatment for acute COPD exacerbations between December 2012 and January 2017 were analysed. Data were collected on treatment, length of stay, C-reactive protein (CRP), eosinophil count and bacterial sputum culture positivity for potentially pathogenic microorganisms (PPM).

Results

1029 exacerbations were included. There was an inverse correlation between CRP and eosinophil count (rho = −0.277, p < 0.01). The proportion of eosinophilic exacerbations (eosinophils ≥0.3 × 10⁹/L) was low (157, 15%). Median length of stay was longer in patients with a CRP >100 mg/L (4d [3,8] vs 4d [2,7], p < 0.01) or when given antibiotics (4d [2,8] vs 3d [1,6], p < 0.001) and shorter if receiving corticosteroids (4d [2,6] vs 6d [3,7], p < 0.001). Being sputum culture positive on first exacerbation was associated with sputum culture positivity in subsequent exacerbations. Patients with PPM in sputum culture had a significantly higher median CRP than culture negative patients (38 mg/L [18.75, 57] v 18 mg/L [8.5,45.5] p < 0.05). Length of stay, eosinophil count and CRP were significantly correlated between exacerbation pairs.

Conclusions

This real-world population found eosinophilic and high CRP exacerbations to be distinct and significantly stereotyped within individual patients across recurrent exacerbations. High CRP exacerbations are associated with greater healthcare utilisation and chance of sputum positivity with PPM. Eosinophilic exacerbations were associated with lower rate of readmission. Phenotype-driven treatment warrants further investigation in this population.

中文翻译：

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现实世界五年住院队列中的COPD恶化表型。

介绍

在研究人群中，COPD病情恶化的表型主要由感染性或炎症性病因学定义。我们试图在入​​院的患者中进行描述。

材料和方法

分析了2012年12月至2017年1月之间因COPD急性加重而存活的连续出院患者的病例记录。收集有关治疗，停留时间，C反应蛋白（CRP），嗜酸性粒细胞计数和潜在病原微生物（PPM）细菌痰培养阳性的数据。

结果

包括1029例病情加重。CRP和嗜酸性粒细胞计数之间呈负相关（rho = -0.277，p <0.01）。嗜酸性粒细胞增多的比例（嗜酸性粒细胞≥0.3×10 ⁹/ L）低（157，15％）。CRP> 100 mg / L（4d [3,8] vs 4d [2,7]，p <0.01）或接受抗生素治疗（4d [2,8] vs 3d [1]的患者中位住院时间更长，6]，p <0.001），如果接受皮质类固醇激素治疗则更短（4d [2,6] vs 6d [3,7]，p <0.001）。在首次加重时痰培养呈阳性与随后加重时痰培养阳性有关。痰培养中PPM患者的CRP中位数显着高于培养阴性患者（38 mg / L [18.75，57] v 18 mg / L [8.5,45.5] p <0.05）。病程延长之间，住院时间，嗜酸性粒细胞计数和CRP显着相关。

结论

这个现实世界的人群发现嗜酸性粒细胞和高CRP加重在反复发作的各个患者中是截然不同的并且明显刻板印象。高CRP加重与更高的医疗保健利用率以及PPM痰阳性的机会有关。嗜酸性粒细胞的恶化与再入院率降低有关。表型驱动的治疗值得对该人群进行进一步研究。