Cancer biomarkers: Emerging trends and clinical implications for personalized treatment

The integration of cancer biomarkers into oncology has revolutionized cancer treatment, yielding remarkable advancements in cancer therapeutics and the prognosis of cancer patients. The development of personalized medicine represents a turning point and a new paradigm in cancer management, as biomarkers enable oncologists to tailor treatments based on the unique molecular profile of each patient's tumor. In this review, we discuss the scientific milestones of cancer biomarkers and explore future possibilities to improve the management of patients with solid tumors. This progress is primarily attributed to the biological characterization of cancers, advancements in testing methodologies, elucidation of the immune microenvironment, and the ability to profile circulating tumor fractions. Integrating these insights promises to continually advance the precision oncology field, fostering better patient outcomes.

Age at diagnosis, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognoticators in pediatric sinonasal rhabdomyosarcoma

BACKGROUND

The relationship between pretreatment blood parameters and clinical outcomes of patients with pediatric sinonasal rhabdomyosarcomas has not been described. The purpose of this study was to determine the prognostic factors and certain laboratory parameters that affect the survival and long-term survival in pediatric sinonasal rhabdomyosarcoma.

METHODS

Medical records of pediatric sinonasal rhabdomyosarcoma cases who were treated and followed up between 2004 and 2020 in Hacettepe University were retrospectively reviewed. The relationship between clinical features, laboratory parameters and survival was investigated.

RESULTS

Age at the time of diagnosis, pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had significant effect on survival (p < 0,004, p < 0,037, p < 0,016, respectively). Survival rate was higher in patients younger than 10 (≤10 years of age) at the time of diagnosis (p = 0,004), patients with a NLR of 2 or below (≤2) (p = 0,037), and patients with a PLR of 150 or below (≤150) (p = 0,016). ≤ 10 years of age at the time of diagnosis was found as an independent prognostic factor affecting survival (hazard ratio [HR], 5382; 95 % confidence interval [CI], 1476- 19,623; P = 0,011). In addition, a pretreatment PLR of 150 or below (≤150) was found as another independent prognostic factor that affects survival (hazard ratio [HR], 4386; 95 % confidence interval [CI], 1161- 16,567; P = 0,029).

CONCLUSIONS

Preoperative NLR and PLR may be important parameters to predict the prognosis of pediatric sinonasal rhabdomyosarcoma. Further research with larger patient groups are warranted.

Soluble biomarkers to predict clinical outcomes in non-small cell lung cancer treated by immune checkpoints inhibitors

Lung cancer remains the first cause of cancer-related death despite many therapeutic innovations, including immune checkpoint inhibitors (ICI). ICI are now well used in daily practice at late metastatic stages and locally advanced stages after a chemo-radiation. ICI are also emerging in the peri-operative context. However, all patients do not benefit from ICI and even suffer from additional immune side effects. A current challenge remains to identify patients eligible for ICI and benefiting from these drugs. Currently, the prediction of ICI response is only supported by Programmed death-ligand 1 (PD-L1) tumor expression with perfectible results and limitations inherent to tumor-biopsy specimen analysis. Here, we reviewed alternative markers based on liquid biopsy and focused on the most promising biomarkers to modify clinical practice, including non-tumoral blood cell count such as absolute neutrophil counts, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and derived neutrophil to lymphocyte ratio. We also discussed soluble-derived immune checkpoint-related products such as sPD-L1, circulating tumor cells (detection, count, and marker expression), and circulating tumor DNA-related products. Finally, we explored perspectives for liquid biopsies in the immune landscape and discussed how they could be implemented into lung cancer management with a potential biological-driven decision.

Short-term impacts of air pollution on the platelet-lymphocyte ratio and neutrophil-lymphocyte ratio among urban adults in China

The short-term impacts of urban air pollution on the platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) remain obscure. In this study, we included 3487 urban adults from the Wuhan-Zhuhai cohort. Individual inhalation exposure to air pollutants was estimated by combining participants' daily breath volume and ambient concentrations of six air pollutants (including fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO) and ozone (O₃)). The cumulative impacts were assessed by applying lag structures of up to 7 days before the survey date. Associations of air pollutants with PLR and NLR were assessed using a linear mixed model and Bayesian kernel machine regression (BKMR) model. We found that PLR was negatively related to PM_2.5 (lag02-lag06), PM₁₀ (lag02-lag07), NO₂ (lag02-lag07), and SO₂ (lag03-lag05) and NLR was negatively related to PM₁₀ (lag05 and lag07). In the BKMR model, a negative joint association between the six-air-pollutant mixture and PLR and NLR was observed, whereas PM₁₀ and NO₂ appeared to be more important than the other pollutants in the mixture. The negative impact of air pollutants was stronger in males, participants with lower body mass index (< 24 kg/m²), those cooking meals at home, drinkers, and non-exercisers. In conclusion, short-term exposure to air pollutants is significantly related to PLR and NLR in peripheral blood. PLR and NLR may provide new insight into the molecular mechanism underlying the adverse health impact of air pollutants.

Prognostic significance of preoperative neutrophil-to-lymphocyte ratio in surgically resected schwannomas

Objective

The goal of schwannoma resection is to control the tumor while preserving neurological function. Schwannomas have a variable postoperative growth pattern, therefore preoperative prediction of a schwannoma's growth pattern is favorable. This study aimed to examine the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and postoperative recurrence and retreatment in patients with schwannoma.

Methods

We retrospectively examined 124 patients who underwent schwannoma resection in our institution. Associations between preoperative NLR, other patient and tumor characteristics, and tumor recurrence and retreatment were analyzed.

Results

Median follow-up was 2569.5 days. Postoperative recurrence occurred in 37 patients. Recurrence that required retreatment occurred in 22. Treatment-free survival (TFS) was significantly shorter in patients with NLR ≥2.21 (P = 0.0010). Multivariate Cox proportional hazards regression showed that NLR and neurofibromatosis type 2 were independent predictors of retreatment (P = 0.0423 and 0.0043, respectively). TFS was significantly shorter in patients with NLR ≥2.21 in the following subgroups: sporadic schwannoma, primary schwannoma, schwannoma ≥30 mm in size, subtotal resection, vestibular schwannoma, and postoperative recurrence.

Conclusions

Preoperative NLR ≥2.21 before surgery was significantly associated with retreatment after schwannoma resection. NLR may be a novel predictor of retreatment and assist surgeons in preoperative surgical decision making.

The Correlation of Systemic Immune Inflammation Index, Neutrophil to Lymphocyte Ratio, Derived Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio with Disease Severity in Recurrent Aphthous Stomatitis

BACKGROUND/AIM

To evaluate the correlation of systemic Immune Inflammation Index (SII), neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) with disease severity in recurrent aphthous stomatitis (RAS).

METHODS

The present retrospective cohort study was performed on patients with RAS. Patients were divided into three groups: 1) Major (n=75), 2) Minor (n=123), and 3) Herpetiform aphthae (n=17). The study groups were compared in terms of demographic features, acute phase proteins, and complete blood cell count parameters. Moreover, correlation analyses were performed for the correlation of ulcer severity score (USS) with C-reactive protein (CRP), SII, erythrocyte sedimentation rate (ESR), ferritin, dNLR, NLR and PLR.

RESULTS

Significantly higher values were observed for USS, neutrophil count, ferritin, SII, NLR and dNLR (p<0.05 for all) in the major and herpetiform aphtae groups compared to the minor aphtae group. Positive, strong, significant correlations were observed between USS, SII and NLR (r=0.80 for SII, r=0.74 for NLR and p<0.001 for both). Positive, moderate, significant correlations were observed between USS, PLR, ESR and CRP (r=0.54 for PLR, r=0.39 for ESR, r=0.36 for CRP and p<0.001 for all). Positive, weak, significant correlations were observed between USS, dNLR and ferritin (r=0.13 and p=0.05 for ferritin, r=0.27 and p<0.001 for dNLR).

CONCLUSION

Higher values of SII, NLR, dNLR, and PLR were associated with disease severity in patients with RAS.

The relationship between NLR/PLR/LMR levels and survival prognosis in patients with non-small cell lung carcinoma treated with immune checkpoint inhibitors

BACKGROUND

The relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) and the dire prognosis of non-small cell lung carcinoma patients who received immune checkpoint inhibitors (ICIs) are not known yet.

METHODS

We screened the articles that meet the criteria from the database. The relationship between NLR/PLR/LMR levels and the survival and prognosis of non-small cell lung cancer patients treated with ICIs was analyzed. Summarize hazard ratio (HR) with 95% confidence interval (CI) to study progression-free survival (PFS) and overall survival (OS).

RESULTS

Thirty-four studies involving 3124 patients were enrolled in the final analysis. In short, high pre-treatment NLR was related to poor OS (HR = 2.13, 95% CI:1.74-2.61, P < .001, I2 = 83.3%, P < .001) and PFS (HR = 1.77, 95% CI:1.44-2.17, P < .001, I2 = 79.5%, P < .001). Simultaneously, high pre-treatment PLR was related to poor OS (HR = 1.49, 95% CI:1.17-1.91, P < .001, I2 = 57.6%, P = .003) and PFS (HR = 1.62, 95% CI:1.38-1.89, P < .001, I2 = 47.1%, P = .036). In all subgroup analysis, most subgroups showed that low LMR was related to poor OS (HR = 0.45, 95% CI: 0.34-0.59, P < .001) and PFS (HR = 0.60, 95% CI: 0.47-0.77, P < 0.001, I2 = 0.0%, P < .001).

CONCLUSION

High pre-treatment NLR and pre-treatment PLR in non-small cell lung carcinoma patients treated with ICIs are associated with low survival rates. Low pre-treatment and post-treatment LMR are also related to unsatisfactory survival outcomes. However, the significance of post-treatment NLR and post-treatment PLR deserve further prospective research to prove.

Elevated serum CA19-9 indicates severe liver inflammation and worse survival after curative resection in hepatitis B-related hepatocellular carcinoma

We explored the prognostic value of preoperative CA19-9 in α-fetoprotein (AFP)-positive and -negative HCC with hepatitis B virus (HBV) background (HBV-HCC), and explored the underlying mechanism. Recurrence-free survival (RFS) and overall survival (OS) were assessed in HBV-HCC patients who underwent curative resection (Cohort 1). Immunohistochemical staining of CA19-9 in HCC and liver parenchyma were quantified in another cohort of 216 patients with resected HCC (Cohort 2). Immunohistochemical staining of CA19-9 and serum CA19-9 level was also compared between patients with HCC and intrahepatic cholangiocarcinoma (ICC) (Cohort 3). In Cohort 1, CA19-9 ≥ 39 U/mL was an independent risk factor for RFS (HR = 1.507, 95% CI = 1.087-2.091, p = 0.014) and OS (HR = 1.646, 95% CI = 1.146-2.366, p = 0.007). CA19-9 ≥ 39 U/mL was also associated with significantly higher incidence of macrovascular invasion (MaVI) compared with CA19-9 < 39 U/mL (23.0% vs. 7.2%, p = 0.002), and elevated aminotransferase and aspartate aminotransferase to platelet ratio index (APRI), and lower albumin. Immunohistochemical staining of CA19-9 revealed that CA19-9 expression was found exclusively in the background liver but not in HCC tumor cells. In contrast, tumor tissue was the main source of CA19-9 in ICC patients. CA19-9 ≥ 39 U/mL was associated with worse OS and RFS in both AFP-positive and negative HCC patients. CA19-9 indicated more severe inflammation and cirrhosis in the liver of HCC patients.

Neutrophil-Lymphocyte Ratio as a Predictive Factor of Growing Malignant Pulmonary Ground-glass Opacity

Background

The object of the study was to elucidate the relationship between the neutrophil–lymphocyte ratio (NLR) and the growth of pulmonary ground-glass opacity (GGO) in stage IA lung adenocarcinoma.

Methods

All patients with GGO following surgical procedures were enrolled, with the time of follow-up and the variation tendency of GGO recorded. Meanwhile, laboratory parameters, age, gender, smoking history, histology, tumor size, and stage were recorded. Logistic regression was used to evaluate the value of NLR and the cutoff value was calculated by SPSS 22.0.

Results

In the whole cohort, 30 cases of growing GGO and 43 cases of stable GGO undergoing surgical procedures were diagnosed as lung adenocarcinoma. There was significant statistical difference between the two groups. Multivariable analysis showed that NLR could predict the GGOs with growth (odds ratio 5.198, 95% confidence interval (95%CI: 1.583–14.581, P=0.002). Receiver operating characteristics analysis for NLR showed the optimal cutoff value of 2.38, with a sensitivity of 60.0% and specificity of 81.4%.

Conclusion

Our study demonstrated that the NLR appeared to have value as a promising clinical predictor of GGOs with growth. Further studies are needed to confirm this conclusion.

The predictive value of neutrophil-to-lymphocyte ratio for chronic obstructive pulmonary disease: a systematic review and meta-analysis

INTRODUCTION

There was inconsistent results regarding the associations of neutrophil to lymphocyte ratio (NLR) with the progression and prognosis of chronic obstructive pulmonary disease (COPD).

AREAS COVERED

This paper assess the role of NLR on the progression and prognosis of COPD using a meta-analytic approach. PubMed, EmBase, and the Cochrane library were systematically searched. The pooled weighted mean differences and odds ratios with 95% confidence intervals were applied for continuous and categorical variables using the random-effects model.

EXPECT COMMENATRY

NLR was significantly high when comparing COPD patients to healthy individuals, and acute exacerbation COPD to stable COPD. Moreover, elevated NLR were significantly associated with higher risk of mortality and exacerbation.

Development and Validation of a Novel Nomogram for Predicting Tumor-Distant-Metastasis in Patients with Early T1-2 Stage Lung Adenocarcinoma

Background

Distant metastasis in early T1-2 (diameter≤5 cm) stage lung adenocarcinoma (ET-LUAD) patients largely affect treatment strategies in clinical practice. However, the associated mechanism remains unclear and related studies is less. This study aimed to establish and validate a novel nomogram to predict the risk of distant metastasis in ET-LUAD.

Methods

A total of 258 patients diagnosed with ET-LUAD and not receiving any treatment were recruited into this study. The patients were randomly divided into a training cohort and validation cohort in a ratio of 1:2. Univariate and multivariate logistic regression analysis was used to select the most significant predictive risk factors associated with distant metastasis in the training cohort. The established nomogram was validated by the consistency index (C-index), calibration curve, and decision curve analysis (DCA).

Results

There were 124 patients with confirmed distant metastasis and 134 patients with non-distant metastases ET-LUAD were enrolled in the study. Multivariate logistic hazards regression analysis identified independent risk factors associated with distant metastasis to include platelet-to-lymphocyte ratios (PLR), lactate dehydrogenase (LDH), neural-specific enolase (NSE), carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (Cyfra211), which were included in the establishment of the nomogram. The nomogram achieved a high consistency (C-index=0.792), good calibration, and high clinical application value in the validation cohort.

Conclusion

The established nomogram can be used to predict distant metastasis in high-risk ET-LUAD nonmetastasis patients and can also be used by doctors to guide preventive and individualized treatment for ET-LUAD patients.

Survival and prognostic analysis of preoperative indicators in patients undergoing surgical resections with rhabdomyosarcoma

Several preoperative blood and biochemical parameters are associated with postoperative survival in many kinds of tumors. The aim of this study is to study the predictive value of several routine preoperative blood and biochemical parameters on the prognosis patients with rhabdomyosarcoma (RMS).We retrospectively recruited 55 patients diagnosed with RMS and had surgery at West China Hospital, Sichuan University between January 2010 and December 2018. Baseline characteristics of the patients, tumor features, surgery details, and values of several examinations were extracted. A long-term follow-up was conducted by phone call. A novel statistical analysis was subsequently carried out to look for the relationship of preoperative parameters and patients' prognosis.The ROC analysis showed an area under curve (AUC) of 0.608, 0.620, 0.626, 0.591, and 0.518 for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), lactic dehydrogenase (LDH), and alkaline phosphatase (ALP) respectively, and the cut-off value of 2.843, 162.961, and 0.239 for NLR, PLR, and MLR respectively. The survival analysis showed that certain blood and biochemical parameters could cause differences in overall survival (OS) (P = .005 for NLR, P = .005 for PLR, and P = .007 for MLR) and progression free survival (PFS) (P = .029 for NLR, P = .008 for PLR, and P = .013 for MLR).Several preoperative blood and biochemical parameters are novel prognostic factors in RMS patients. Specifically, a higher NLR, PLR, and MLR value will predict a statistically shorter OS and PFS.In the future, surgeons should care more about NLR, PLR, and MLR values and several other parameters in patients' preoperative normal blood and biochemical tests to predict the postoperative conditions.

Naples prognostic score is an independent prognostic factor in patients with operable endometrial cancer: Results from a retrospective cohort study

OBJECTIVE

Naples prognosis score (NPS) is a new immune and nutritional assessment method that can be used to predict tumor prognosis. This study aimed to identify whether NPS is an independent prognostic indicator of operable endometrial cancer (EC).

MATERIALS AND METHODS

We retrospectively analyzed 1038 patients with endometrial cancer who underwent surgery. Patients were grouped according to NPS (NPS group 0, n = 362; NPS group 1, n = 589; and NPS group 2, n = 87), and differences in clinical characteristics were compared among the groups. Survival analysis was performed by the Kaplan-Meier method, P values were calculated by log-rank test, and prognostic factors were assessed by Cox proportional hazards regression models.

RESULTS

Serum albumin levels, total cholesterol levels, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, total lymphocyte count, CA-125 levels, age, body mass index, FIGO stage, myometrial invasion depth, controlling nutritional status score, and systemic inflammation score were significantly different among the groups; significant differences in progression-free survival(PFS) and overall survival (OS) were also found. On multivariate analysis, NPS was identified as an independent prognostic factor for PFS (NPS group 0 vs. 1: aHR = 4.32, 95%CI = 1.133-16.47; NPS group 0 vs. 2: aHR = 21.336, 95%CI = 3.498-130.121) and OS (NPS group 0 vs. 1: aHR = 5.029, 95%CI = 1.638-15.441; NPS group 0 vs. 2: aHR = 20.789, 95%CI = 4.381-98.664). Moreover, NPS is an independent prognostic factor for PFS and OS in grade 2 or 3 EC (aHR = 7.768, 95%CI = 2.411-25.029 and aHR = 4.717, 95%CI = 1.794-12.407, respectively).

CONCLUSION

High NPS is associated with poor PFS and OS and is a valuable independent prognostic factor in patients with EC.

Predictive value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in non-small cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

BACKGROUND

High neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with poor prognosis in cancer patients treated with Immune checkpoint inhibitors (ICIs). However, whether this relationship exists in non-small cell lung cancer (NSCLC) patients remains unclear. Thus, this meta-analysis was conducted to investigate the prognostic role of NLR and PLR in NSCLC treated with ICIs.

METHODS

Eligible studies that evaluated the value of pre-treatment or post-treatment NLR/PLR in NSCLC patients received ICIs were obtained by searching PubMed, Web of Science, Cochrane Library, and EMBASE. The pooled hazard ratio (HR) and 95% confidence interval (CI) were used to assess the relationship between NLR/PLR and overall survival (OS) and progression-free survival (PFS). Subgroup analysis and publication bias were conducted to investigate heterogeneity.

RESULTS

1845 NSCLC patients from 21 studies were included and three ICIs(nivolumab, pembrolizumab, and atezolizumab) were used. Overall, high NLR was associated with poor OS (HR: 2.50, 95% CI:1.79-3.51, P < 0.001) and PFS (HR: 1.77, 95% CI:1.51-2.01, P < 0.001). Subgroup analyses were consistent with the pooled results. Similarly, the pooled results for PLR showed that elevated PLR was related to inferior OS (HR: 1.93, 95% CI: 1.51-2.01, P < 0.001) and PFS (HR: 1.57, 95%CI: 1.30-1.90, P < 0.001). However, the subgroup analysis based on test time indicated that there was no significant correlation between post-treatment PLR and survival outcomes.

CONCLUSION

NLR and pre-treatment PLR could serve as prognostic biomarkers in NSCLC patients treated with ICIs. However, the value of post-treatment PLR needs further to be evaluated.

Risk Factors and Outcomes of Early Relapse After Curative Resection of Intrahepatic Cholangiocarcinoma

Early relapse after hepatectomy for intrahepatic cholangiocarcinoma (ICC) has a tremendous influence on the long-term survival outcomes of ICC patients. The purpose of our study was to investigate risk factors for early tumor relapse and confirm whether early relapse was correlated with ICC patients' long-term survival outcomes. Three hundred and twenty-two consecutive ICC patients undergoing partial hepatectomy at Liver Surgery Department of Zhongshan Hospital (Fudan University, Shanghai, China) between January 2005 and December 2011 were included in this retrospectively study. The definition of early relapse had been described as tumor relapse within 24 months after hepatectomy in ICC patients. We identified a total of 168 ICC patients with early relapse and 23 ICC patients with late relapse after hepatectomy. From the time of relapse, the long-term survival outcomes were worse among patients who had early vs. late relapse (median OS 16.5 vs. 44.7 months, respectively; P < 0.0001). The overall survival of the early relapse group was lower than that of the late relapse group (P < 0.0001). Multivariate Cox regression analysis indicated that multiple tumors (hazard ratio [HR], 1.951; 95% CI, 1.382-2.755; P < 0.001), lymphonodus metastasis (HR, 1.517; 95% CI, 1.061-2.168; P = 0.022), and higher serum CA19-9 levels (HR, 1.495; 95% CI, 1.095-2.039; P = 0.011) were independent risk factors of early relapse. Moreover, multiple tumors (HR, 1.641; 95% CI, 1.120-2.406; P = 0.011), lymphonodus metastasis (HR, 2.008; 95% CI, 1.367-2.949; P < 0.001), elevated NLR (HR, 1.921; 95% CI, 1.331-2.774; P < 0.001) and higher serum CA19-9 levels (HR, 1.990; 95% CI, 1.409-2.812; P < 0.001) were independent predictors of overall survival for ICC patients with early relapse. Collectively, our findings demonstrated that multiple tumors, lymphonodus metastasis, and higher serum CA19-9 levels were associated with the increased risks of early relapse and worse prognoses of ICC after curative-intent resection.

Relationship between neutrophil-lymphocyte ratio and short-term prognosis in the chronic obstructive pulmonary patients with acute exacerbation

We retrospectively collected data from a large sample size of population and explore the relationship between neutrophil–lymphocyte ratio (NLR) and adverse outcomes, and assessed the clinical prognostic utility of NLR in patients with chronic obstructive pulmonary patients with acute exacerbation (AECOPD). We reviewed 3 years medical case records, 622 patients were identified including 48 died and 574 alive. Compared with alive group, the died group had significantly elevated neutrophils, lymphocyte, and NLR level (P<0.001). The high-sensitive C-protein level of died group was also higher compared with alive group (7.48 ± 4.2 vs 1.26 ± 0.56, vs P<0.001). The univariate logistic regression indicated that elevated NLR level was associated with the increased of adverse outcome (odds ratio [OR] = 4.59, 95% CI: 2.27–8.94, P<0.001). After adjusted potential confounding factors, the elevated NLR level was still associated with adverse outcomes in the chronic obstructive pulmonary patients with acute exacerbation (OR = 2.05, 95% CI: 1.21–3.48, P=0.008). The area under the receiver operating characteristic curve for death at 90 days was 0.742 (95% CI: 0.554–0.881). NLR cutoff of >4.19 had a sensitivity of 71.4% and specificity of 74.2%. Our results suggested that NLR, as a rapid, inexpensive and easily obtained blood routine index was associated with short-term adverse outcomes in patients with AECOPD. The elevated NLR predicted the increased the risk of 90-day mortality in patients with AECOPD.