학술논문
Clinical Implications of Low Absolute Blood Eosinophil Count in the SPIROMICS COPD Cohort.
Document Type
Academic Journal
Author
LeMaster WB; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN.; Quibrera PM; University of North Carolina, Chapel Hill, NC.; Couper D; University of North Carolina, Chapel Hill, NC.; Tashkin DP; Division of Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA.; Bleecker ER; Department of Medicine, University of Arizona, Tucson, AZ.; Doerschuk CM; University of North Carolina, Chapel Hill, NC.; Ortega VE; Division of Respiratory Medicine, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ.; Cooper C; Division of Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA.; Han MK; University of Michigan School of Medicine, Ann Arbor, MI.; Woodruff PG; Department of Medicine, University of California, San Francisco, San Francisco, CA.; O'Neal WK; University of North Carolina, Chapel Hill, NC.; Anderson WH; University of North Carolina, Chapel Hill, NC.; Alexis NE; University of North Carolina, Chapel Hill, NC.; Bowler RP; National Jewish Health, Denver, CO.; Barr RG; Presbyterian Hospital, Columbia University Medical Center, New York, NY.; Kaner RJ; Weill Cornell Medical College, New York, NY.; Dransfield MT; University of Alabama Birmingham and Birmingham VA Medical Center, Birmingham, AL.; Paine R 3rd; University of Utah, Salt Lake City, UT.; Kim V; Department of Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA.; Curtis JL; University of Michigan School of Medicine, Ann Arbor, MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI.; Martinez FJ; Weill Cornell Medical College, New York, NY.; Hastie AT; Atrium Health Wake Forest Baptist, School of Medicine, Winston Salem, NC.; Barjaktarevic I; Division of Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA. Electronic address: ibarjaktarevic@mednet.ucla.edu.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) considers blood eosinophil counts < 100 cells/μL (BEC ≤100 ) in people with COPD to predict poor inhaled corticosteroid (ICS) responsiveness. However, the BEC ≤100 phenotype is inadequately characterized, especially in advanced COPD.
Research Question: Are there differences between GOLD group D patients with high BEC and those with low BEC regarding baseline characteristics and longitudinal outcomes?
Study Design and Methods: We used multivariable mixed models and logistic regression to contrast clinical characteristics and outcomes of BEC≤100 vs BEC > 100 (BEC 100+ ) in all subjects with COPD (n = 1,414) and GOLD group D subjects (n = 185) not receiving ICS.
Results: We identified n = 485 with BEC≤100 (n = 61 GOLD group D) and n = 929 people with BEC 100+ (n = 124 GOLD group D). BEC ≤100 status was stable at 6 weeks and approximately 52 weeks (intraclass correlations of 0.78 and 0.71, respectively). Compared with BEC 100+ , BEC ≤100 comprised more women, with greater current smoking, and less frequent childhood asthma. Among all analyzed participants, the two BEC-defined subsets showed similar rates of lung function decline (mean slope, BEC ≤100 vs BEC 100+ , -50 vs -39 mL/y; P = .140), exacerbations (0.40 vs 0.36/y; P = .098), subsequent ICS initiation (2.5% vs 4.4%; P = .071), and mortality (7.8% vs 8.4%; P = .715). However, in GOLD group D, people with BEC ≤100 showed higher exacerbation rates within 365 days of enrollment (0.62 vs 0.33/y; P = .002) and total follow-up (1.16 vs 0.83/y; P = .014). They also had greater lung function decline (mean slope of -68 mL/y vs -23 mL/y; P = .036) and had greater emphysema at baseline (voxels < 950 Hounsfield units at total lung capacity of 7.46% vs 4.61%; P = .029).
Interpretation: In non-ICS-treated GOLD group D COPD, people with BEC≤100 had more baseline emphysema, prospective exacerbations, and lung function decline. Our analysis has identified a particularly vulnerable subpopulation of people with COPD, suggesting the need for studies focused specifically on their therapeutic treatment.
Clinical Trial Registration: ClinicalTrials.gov; No.: NCT01969344; URL: www.
Clinicaltrials: gov.
(Copyright © 2023. Published by Elsevier Inc.)
Research Question: Are there differences between GOLD group D patients with high BEC and those with low BEC regarding baseline characteristics and longitudinal outcomes?
Study Design and Methods: We used multivariable mixed models and logistic regression to contrast clinical characteristics and outcomes of BEC
Results: We identified n = 485 with BEC
Interpretation: In non-ICS-treated GOLD group D COPD, people with BEC
Clinical Trial Registration: ClinicalTrials.gov; No.: NCT01969344; URL: www.
Clinicaltrials: gov.
(Copyright © 2023. Published by Elsevier Inc.)