Abstract
Background
Th aim of this study was to analyze acute exacerbation of chronic obstructive pulmonary
disease (AECOPD) readmission events and to determine whether neutrophil-to-lymphocyte
ratio (NLR) and bilirubin levels were associated with readmission after discharge
due to AECOPD.
Methods
A total of 170 patients with AECOPD were included. Patients were stratified into the
readmission group if patients had two or more readmissions within 2 years of the previous
discharge, and the non-readmission group with one readmission or none within 2 years
of the last discharge. Data were collected and compared between groups. The patients
were separated by the cutoffs of NLR and bilirubin level. The number of all-cause
readmissions within 2 years, time to first COPD-related readmission, 1-year/2-year
COPD-related readmission, 1-year/2-year all-cause mortality were compared between
groups, respectively.
Results
Compared with the readmission group, patients of the non-readmission group had a shorter
length of hospital stay, more systemic corticosteroid use, higher NLR, higher bilirubin
levels, and lower eosinophils counts (p < 0.05). NLR and bilirubin levels on admission had significant association with the
number of all-cause readmissions (p < 0.05). Lower bilirubin was associated with an increased risk of 1-year COPD-related
readmission (OR 5.063) and 2-year COPD-related readmission (OR 4.699).
Conclusions
For patients with AECOPD, longer hospital stay, and less use of systemic corticosteroids
may be associated with a higher risk of readmission. NLR and bilirubin levels on admission
may be related to the number of all-cause readmissions. Bilirubin can be regarded
as a biomarker to predict readmission rates within 2 years after discharged throughout
the course of the disease.
Key Indexing Terms
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References
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2019 report [EB/OL]. [2018-12-02]. Available at: https://goldcopd.org/gold-reports/
- Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study.Lancet North Am Ed. 2018; 391: 1706-1717
- Disease burden of COPD in China: a systematic review.Int J Chron Obstruct Pulmon Dis. 2018; 13: 1353-1364
- AIMAR survey on COPD phenotypes.Multidiscip Respir Med. 2014; 9: 16
- NSFC health research funding and burden of disease in China.PLoS One. 2014; 9e111458
- Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.Lancet North Am Ed. 2016; 387: 251-272
- Preventing hospitalizations from acute exacerbations of chronic obstructive pulmonary disease.Am J Med Sci. 2017; 353: 31-40
- Omics and the search for blood biomarkers in chronic obstructive pulmonary disease. Insights from COPDGene.Am J Respir Cell Mol Biol. 2019; 61: 143-149
- Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives.Eur Respir Rev. 2018; 27
- Relationship between neutrophil-lymphocyte ratio and short-term prognosis in the chronic obstructive pulmonary patients with acute exacerbation.Biosci Rep. 2019; 39
- Can we predict the prognosis of COPD with a routine blood test?.Int J Chron Obstruct Pulmon Dis. 2017; 12: 615-625
- The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease.Medicine. 2019; 98 (Baltimore): e16371
- Serum bilirubin and the risk of chronic obstructive pulmonary disease exacerbations.Respir Res. 2017; 18: 179
- Acute exacerbations of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2011; 184: 662-671
- Systemic Corticosteroid and antibiotic use in hospitalized patients with chronic obstructive pulmonary disease exacerbation.Ann Pharmacother. 2019; 53: 144-150
- Systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease.Am J Health Syst Pharm. 2010; 67: 1061-1069
- Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2014; CD001288
- Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial.JAMA. 2013; 309: 2223-2231
- Blood eosinophilia as a marker of early and late treatment failure in severe acute exacerbations of COPD.Respir Med. 2017; 131: 118-124
- Greater eosinophil counts at first COPD hospitalization are associated with more readmissions and fewer deaths.Int J Chronic Obstr Pulm Dis. 2019; 14: 331-341
- Eosinophils in COPD exacerbations are associated with increased readmissions.Chest. 2017; 151: 366-373
- Eosinophil counts in first COPD hospitalizations: a comparison of health service utilization.Int J Chron Obstruct Pulmon Dis. 2018; 13: 3045-3054
- Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study.Inflammation. 2014; 37: 374-380
- Association of the neutrophil-to-lymphocyte ratio with lung function and exacerbations in patients with chronic obstructive pulmonary disease.PLoS One. 2016; 11e0156511
- The neutrophil to lymphocyte ratio is related to disease severity and exacerbation in patients with chronic obstructive pulmonary disease.Intern Med. 2016; 55: 223-229
- A revised treatment approach for hospitalized patients with eosinophilic and neutrophilic exacerbations of chronic obstructive pulmonary disease.Turk Thorac J. 2018; 19: 193-200
- The utility of inflammatory markers to predict readmissions and mortality in COPD cases with or without eosinophilia.Int J Chron Obstruct Pulmon Dis. 2015; 10: 2469-2478
- Bilirubin: its role in cytoprotection against oxidative stress.Int J Biochem Cell Biol. 2002; 34: 216-220
- Association of serum bilirubin level with lung function decline: a Korean community-based cohort study.Respir Res. 2018; 19: 99
- Serum bilirubin is associated with lung function in a Swiss general population sample.Eur Respir J. 2014; 43: 1278-1288
- p38alpha MAP kinase as a sensor of reactive oxygen species in tumorigenesis.Cancer Cell. 2007; 11: 191-205
- Serum bilirubin and risk of respiratory disease and death.JAMA. 2011; 305: 691-697
Article info
Publication history
Published online: September 23, 2022
Accepted:
May 19,
2022
Received:
September 24,
2020
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
