Association of the Neutrophil-to-Lymphocyte Ratio with Lung Function and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Mechanisms coupling the mTOR pathway to chronic obstructive pulmonary disease (COPD) pathogenesis

Chronic Obstructive Pulmonary Disease (COPD) is a poorly reversible respiratory disorder distinguished by dyspnea, cough, expectoration and exacerbations due to abnormality of airways or emphysema. In this review, we consider the therapeutic potential of targeting Mammalian target of Rapamycin (mTOR) for treating COPD. The mTOR is a highly conserved serine-threonine protein kinase that integrates signals from growth factors and nutrients to control protein synthesis, lipid biogenesis and metabolism. Dysregulated mTOR pathway signaling due to genetic factors or cigarette smoking impairs autophagy, driving the buildup of abnormal cells and damaged proteins, resulting in inflammation and oxidative stress. Persistent mTOR activation also contributes to pulmonary vascular cell proliferation, facilitating the development of pulmonary resistance in COPD. Rapamycin, an inhibitor of mTOR, prevents the buildup of senescent cells in the lungs of COPD patients and inhibits the release of lung tissue-damaging proteases. mTOR also impacts the corticosteroid sensitivity in COPD patients by regulating the levels of histone deacetylases. The emerging role of gut-lung axis dysbiosis in the progression of COPD and its influence on mTOR further highlights the relevance of the mTOR pathway in COPD pathophysiology.

Association of neutrophil-to-lymphocyte ratio and CRP with spirometry in COPD patients in North India

Background

Patients with chronic obstructive pulmonary disease (COPD) who have high serum levels of C-reactive protein (CRP), a marker of low-grade systemic inflammation, exhibit reduced lung functions and a worse prognosis. The neutrophil-to-lymphocyte ratio (N/L ratio, NLR), obtained from a complete blood count, is an inexpensive and easily accessible inflammation marker. The NLR has proven useful in assessing the risk for patients with various cardiovascular conditions, different types of solid tumours, sepsis, and infectious diseases. Research indicates that COPD patients have significantly higher NLR values compared to healthy controls of the same age and sex, with these values increasing even more during acute COPD exacerbations compared to stable periods. Hence, identifying non-invasive and cost-effective tools to assess the severity of COPD in the PHC/CHC level would be beneficial as an early intervention.

Aim

To study the relationship between N/L ratio and CRP levels and spirometry in COPD patients.

Settings and Study Design

Observational cross-sectional study.

Methods and Material

A total of 100 patients of an age > 40 years with a confirmed diagnosis of COPD according to GOLD (Global Initiative COPD patients) criteria were selected. With an informed consent, blood sample collection for N/L ratio and CRP along with spirometry was performed in all the patients.

Statistical Analysis Used

SPSS software with Student t-test, Chi-square t-test, ANOVA, and Spearman correlation with 95% CI is used. P <0.05 is considered significant.

Results

NLR was observed to be higher in the moderate grade of COPD patients. All the patients were observed with an abnormal (>5 mg/L) CRP level. FEV1, FVC%, FEV1/FVC%, N/L ratio, and CRP were significantly (P < 0.0001*) associated with severity COPD according to GOLD criteria.

Conclusions

This study concludes that the FEV1, FVC, and FEV1/FVC ratio were lower in severe COPD patients, and it also reveals that individuals with severe COPD have elevated levels of serum CRP and N/L ratio, which correlates with the severity of COPD. Elevated N/L ratio and CRP level may be used as non invasive predictors and cost-effective tools for COPD patients at the Primary health centre level for screening of the severity of COPD patients.

Combined Inflammatory Markers for Predicting Acute Exacerbations in Chronic Obstructive Pulmonary Disease With Respiratory Failure

Objective

This study aimed to assess the predictive value of the neutrophil-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and serum amyloid A (SAA) in predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure (RF).

Methods

A retrospective study was conducted on 198 patients with AECOPD in the Respiratory Department of No. 2 People's Hospital of Fuyang City from December 2022 to May 2023. Patients were categorized into two groups: an experimental group with the presence of RF (n = 70) and a control group with no RF present (n = 128). Baseline characteristics and inflammatory marker levels were compared between the two groups, and their impact on the risk of readmission within one year was analyzed to assess the predictive value of NLR, CAR, and SAA in patients with AECOPD and RF.

Results

The experimental group exhibited significantly higher levels of white blood cells, neutrophils, C-reactive protein (CRP), SAA, NLR, and CAR compared to the control group. Additionally, the experimental group had a higher one-year readmission rate, with statistically significant differences. The areas under the receiver operating characteristic (ROC) curve for NLR, CAR, and SAA in predicting AECOPD with RF were 0.705, 0.659, and 0.656, respectively. When combined, the ROC area under the curve for these three markers increased to 0.717, which was statistically significant.

Conclusion

The combined assessment of NLR, CAR, and SAA offers a reliable reflection of systemic inflammation and holds predictive value for AECOPD with RF.

Prognostic value of composite inflammatory markers in patients with chronic obstructive pulmonary disease: A retrospective cohort study based on the MIMIC-IV database

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease, and inflammation plays a key role in the pathogenesis of COPD. The aim of this study is to investigate the association between systemic immune inflammation index (SII), systemic inflammatory response index (SIRI),pan-immune inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and all-cause mortality in patients with chronic obstructive pulmonary disease (COPD), and to evaluate the effect of composite inflammatory markers on the prognosis of COPD patients. We obtained data on COPD patients from the Medical Information Mart for Intensive Care (MIMIC) -IV database and divided patients into four groups based on quartiles of baseline levels of inflammatory markers, The primary outcomes were in-hospital and ICU mortality. We comprehensively explored the association between composite inflammatory markers and mortality in patients with COPD using restricted cubic splints (RCS), COX proportional hazards regression models, Kaplan-Meier curves, receiver operating characteristic (ROC), and subgroup analyses. A total of 1234 COPD patients were included in this study. RCS results showed that SII, SIRI, PLR, PIV and NLR were positively and non-linearly correlated with the increased risk of in-hospital mortality in COPD patients. Multivariate COX regression analysis showed that compound inflammatory markers were independent risk factors for in-hospital mortality in COPD patients. The KM curve results showed that COPD patients with higher SII, SIRI, PLR and PIV had a significantly lower survival probability. 5 kinds of compound between inflammatory markers and mortality in patients with COPD is related to nonlinear correlation, can increase the risk of mortality in patients with COPD is a risk factor for the prognosis of patients with COPD, and may serve as potential biomarkers for clinical COPD risk stratification and treatment management in critical patients.

Influence of TMPRSS6 genotype on iron status parameters in stable COPD patients

Background

The SNP rs855791 has been linked to increased hepcidin levels, variations in serum iron, transferrin saturation and red blood cell indices. Our goal was to determine the prevalence of this polymorphism among COPD patients and to assess its impact on iron status parameters in patients with stable COPD.

Methods

We analysed iron status parameters and genetic data from 29 COPD patients with wild-type genotype (WT group) and 65 COPD patients with either homozygous or heterozygous genotype (HH group). Additionally, the prevalence of SNP rs855791 was assessed in 192 volunteers.

Results

The frequency distribution of SNP rs855791 was comparable between the COPD patients and control subjects (p=0.791). Iron status parameters were within their respective reference values and showed neither statistically nor clinically significant difference between the WT and HH group of COPD patients. However, after excluding patients with (sub)clinical vitamin B12 deficiency and/or hypoxemia, WT group of patients exhibited significantly lower erythropoietin levels (p=0.015). The area under the curve for erythropoietin was 0.688 (95% CI: 0.545-0.830, p=0.015), with an optimal cut-off of 9.74, sensitivity of 61.2% (95% CI: 58.1-64.3) and specificity of 65.0% (95% CI: 61.8-68.3).

Conclusions

Iron status parameters do not differ between WT and HH groups of stable COPD patients. Statistical but not clinical difference in EPO levels was observed in a subgroup of patients. In addition to promoting erythropoiesis, EPO may regulate hepcidin levels and thus influence the development of iron deficiency and/or anaemia. Also, EPO's direct effect on immune cells and down-regulation of inflammatory reactions should be considered in this context.

Predictive Value of Flow Cytometry Quantification of BAL Lymphocytes and Neutrophils in ILD

Interstitial lung diseases (ILDs) are pathologies affecting the pulmonary interstitium and, less frequently, the alveolar and vascular epithelia. Bronchoalveolar lavage (BAL) is commonly used in ILD evaluation since it allows the sampling of the lower respiratory tract. The prognostic value of BAL cell counts in ILD is unknown. Flow cytometry quantification of lymphocytes and neutrophils in BAL of 1074 real-life consecutive patients were retrospectively correlated with clinical, radiological, anatomopathological, functional/spirometry, and evolutionary data. Cut-offs with predictive value were established at 7% and 5% for lymphocytes and neutrophils, respectively. Three risk stratification groups (Risk-LN) were established: FAVORABLE (lymphocytes > 7% and neutrophils < 5%), INTERMEDIATE (rest of patients), and UNFAVORABLE (lymphocytes < 7% and neutrophils > 5%), showing 75th percentile overall survival (OS) of 10.0 ± 1.4, 5.8 ± 0.6, and 3.0 ± 0.3 years (p < 0.001), respectively. A scoring model combining Risk-LN and the age of the patients with great predictive capacity for OS on fibrotic and non-fibrotic ILDs is proposed. This score is an independent predictive factor (HR = 1.859, p = 0.002) complementary to the fibrosis status (HR = 2.081, p < 0.001) and the type of treatment. Flow cytometry of BAL provides rapid and accurate quantification of lymphocytes and neutrophils, allowing the establishment of a risk score model that is useful in the clinical management of fibrotic and non-fibrotic ILDs from the time of diagnosis.

Predictive value of neutrophil-to-lymphocyte ratio for adverse outcomes in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: A retrospective study

Chronic obstructive pulmonary disease (COPD) stands as one of the leading causes of mortality worldwide. Acute exacerbations of COPD (AECOPD) lead to rapid respiratory function decline and worsened disease status. Despite recent studies, the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with COPD remains controversial. We investigated the predictive value of NLR for adverse outcomes in hospitalized patients with AECOPD. A retrospective study was conducted at the Department of Pulmonary Medicine, Cho Ray Hospital (Vietnam) from November 2019 to November 2021. The study extracted data from patients diagnosed with AECOPD at discharge and met the inclusion criteria. NLR is calculated by dividing the number of neutrophils by the number of lymphocytes in the peripheral blood test. Adverse outcomes are defined as invasive mechanical ventilation, admission to intensive care unit, or in-hospital mortality. Multivariable regression analysis was conducted to identify variables predicting adverse outcomes. The cutoff, sensitivity, specificity, area under the curve, and receiver operating characteristic of NLR were determined for predicting adverse outcomes. Two hundred eighty-seven patients with AECOPD were included in the final analysis, with a mean age of 70.9, and males comprising 92.7%. The rate of adverse outcomes was 15.7%. Multivariable logistic regression identified reduced consciousness at admission (adjusted odds ratio = 0.08, 95% confidence interval [CI]: 0.02-0.38, P = .001) and high NLR (adjusted odds ratio = 1.17, 95% CI: 1.10-1.24, P < .001) as predictors of adverse outcomes. The receiver operating characteristic of NLR's predictive value yielded an area under the curve of 0.877 (95% CI: 0.83-0.93). An NLR cutoff of 11.0 predicted adverse outcomes with a sensitivity of 80.0%, specificity of 77.7%, and an odds ratio of 13.9 (95% CI: 6.3-30.7), P < .001. NLR is a simple, routine, and cost-effective tool for predicting adverse outcomes in hospitalized patients with AECOPD. Future studies should evaluate the kinetics of NLR in predicting treatment response in patients with AECOPD.

Neutrophil-to-lymphocyte ratio as a biomarker of acute pulmonary exacerbations in children with cystic fibrosis: a retrospective cohort study

BACKGROUND

Neutrophils are key contributors to chronic airway inflammation in cystic fibrosis (CF) lung disease, although airway and blood-based neutrophil markers are seldom used. The neutrophil-to-lymphocyte ratio (NLR) is an accessible biomarker, the clinical utility of which has not been adequately studied.

OBJECTIVE

This study aimed to investigate the characteristics of the NLR in children with CF and its correlations with acute pulmonary exacerbations and spirometry.

DESIGN

A previous study had collected clinical data from children with CF for a 3-year period between 2016 and 2021. Retrospectively, NLR values were categorised according to patients' clinical status during blood sample collection as 'stable', 'acute pulmonary exacerbation' or 'elective admission for chronic clinical concern'.

MAIN OUTCOME MEASURES

Demographic characteristics associated with the NLR; changes in NLR values in relation to clinical status; relationship between NLR and lung function.

RESULTS

141 children with CF were included. NLR values during clinical stability were higher in females and increased with age. For children admitted for intravenous antibiotics, NLR values significantly increased from clinical stability (median (IQR)=1.13 (0.75-1.51)) to acute pulmonary exacerbations (median (IQR)=1.50 (0.96-2.65), p=0.001), but similar changes were not observed in elective admissions. The NLR was not associated with lung function.

CONCLUSIONS

The NLR demonstrated associations with clinical status in children with CF with significant elevations during acute pulmonary exacerbations. While its utility as a single-marker measure is limited, monitoring the NLR over time may help identify periods of increased inflammation.

Relationship between neutrophil lymphocyte ratio and red blood cell distribution width and respiratory failure in COPD patients

The neutrophil lymphocyte ratio (NLR) and red blood cell distribution width (RDW) have been repeatedly demonstrated to be associated with risk of severity, progression, and prognosis of chronic obstructive pulmonary disease (COPD), but data on respiratory failure (RF) in patients with COPD are very limited. This study aimed to examine the relationship between NLR and RDW and the incident RF in patients with COPD. This is a retrospective study that reviewed data by examining the hospitalization medical records to identify those who were admitted with a diagnosis of COPD. Based on whether RF occurred during index hospitalization, patients were classified as COPD group and COPD combined with RF group. Also, healthy controls of the same age and sex were enrolled in a 1:1 ratio as the COPD group. Univariate comparisons were performed between three groups to examine differences. With the COPD group as reference, multivariable logistic regression was formed to identify the relationship between NLR and RDW and RF, with adjustment for multiple covariates. There were 136 healthy controls, 136 COPD patients and 62 patients with COPD combined with RF included for analysis. There was a significant difference for eight variables, including age, WBC, neutrophil, NLR, RDW, platelet, PLR, and CRP. The Spearman test showed the significant correlation between NLR and WBC (correlation coefficient, 0.38; P = .008), NLR and RDW (correlation coefficient, 0.32; P = .013), and NLR and CRP level (correlation coefficient, 0.54; P < .001). The multivariable logistic regression showed that age (every additional 10 years) (OR, 1.785), NLR (OR, 1.716), RDW (OR, 2.266), and CRP (OR, 1.163) were independently associated with an increased risk of RF. This study demonstrated the independent associative effect of NLR and RDW with RF in patients with COPD, exhibiting the potential clinical role in evaluating the progress of COPD to RF.

Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity

Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests' results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests' results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.

Predictive Role of White Blood Cell Differential Count for the Development of Acute Exacerbation in Korean Chronic Obstructive Pulmonary Disease

Purpose

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic inflammation. Acute exacerbation of COPD (AECOPD) manifests as acute worsening of respiratory symptoms and is associated with high morbidity and mortality. The aim of the present study was to evaluate the predictive value of white blood count (WBC) and its derived inflammatory biomarkers for AECOPD.

Methods

From the Korean COPD Subgroup Study cohort, a prospective and multicenter observational study, 826 patients who had baseline complete blood count (CBC) and 3-year AECOPD data were included. Follow-up CBC data at 1 (n = 385), 2 (n = 294), and 3 (n = 231) years were collected for available patients. The primary outcome was the occurrence of AECOPD at 3 years. The risk of AECOPD was evaluated using a binary logistic analysis.

Results

The cumulative incidences of 12-, 24-, and 36-month AECOPD were 47.6%, 60.5%, and 67.6%, respectively. Patients with AECOPD at 3 years had higher baseline WBC counts, neutrophil counts, neutrophil/lymphocyte ratio (NLR), and neutrophil/monocyte ratio than those without AECOPD. Higher WBC count, neutrophil count, and NLR were associated with the 3-year occurrence of AECOPD in the univariate analysis, but only the higher neutrophil count was a significant risk factor (odds ratio [OR] = 1.468; 95% confidence interval [CI]: 1.024-2.104) in the covariates-adjusted analysis. In the analysis of changes in inflammatory parameters, a decrease in the platelet count (OR = 0.502; 95% CI: 0.280-0.902) and NLR (OR = 0.535; 95% CI: 0.294-0.974) at 2 years and an increase in the eosinophil count (OR = 2.130; 95% CI: 1.027-4.416) at 3 years were significantly associated with AECOPD in the adjusted analysis.

Conclusion

Our data suggest that a high baseline WBC count, particularly neutrophil count, was associated with a higher incidence of long-term AECOPD.

NLR in CBC: A holy grail for biomarker research in COPD?

See related article

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are early predictors of bronchopulmonary dysplasia

To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are correlated with bronchopulmonary dysplasia (BPD) on the first day of prematurity and to help with early warning, identification, and intervention in the development of BPD. From January 2017 to June 2022, newborns who were diagnosed with BPD conducted a retrospective cohort study. Complete blood cells were measured within the first 24 hours of life in preterm neonates of 32 gestational weeks with BPD as the observation group and non-BPD infants as the control group. In all groups, the NLR and PLR levels were measured. Both univariate and multivariate logistic regression analyses were used to evaluate the data. In this research 76 cases of non-BPD and 48 cases of BPD were used as controls. Compared with the non-BPD group, the NLR and PLR levels were considerably higher in the BPD group. Logistic regression analysis suggested that NLR and PLR were independent risk factors for BPD (OR [odds ratio]: 3.786; 95% CI [confidence interval]: 1.75-8.16; P < .05; OR: 3.391; 95% CI: 1.85-28.78; P < .05). The findings may demonstrate that higher NLR and PLR are independently and significantly associated with the development of BPD.

Blood Gene Expression and Immune Cell Subtypes Associated with Chronic Obstructive Pulmonary Disease Exacerbations

Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPDs) are associated with a significant disease burden. Blood immune phenotyping may improve our understanding of a COPD endotype at increased risk of exacerbations. Objective: To determine the relationship between the transcriptome of circulating leukocytes and COPD exacerbations. Methods: Blood RNA sequencing data (n = 3,618) from the COPDGene (Genetic Epidemiology of COPD) study were analyzed. Blood microarray data (n = 646) from the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) study were used for validation. We tested the association between blood gene expression and AE-COPDs. We imputed the abundance of leukocyte subtypes and tested their association with prospective AE-COPDs. Flow cytometry was performed on blood in SPIROMICS (Subpopulations and Intermediate Outcomes in COPD Study) (n = 127), and activation markers for T cells were tested for association with prospective AE-COPDs. Measurements and Main Results: Exacerbations were reported 4,030 and 2,368 times during follow-up in COPDGene (5.3 ± 1.7 yr) and ECLIPSE (3 yr), respectively. We identified 890, 675, and 3,217 genes associated with a history of AE-COPDs, persistent exacerbations (at least one exacerbation per year), and prospective exacerbation rate, respectively. In COPDGene, the number of prospective exacerbations in patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stage ⩾2) was negatively associated with circulating CD8+ T cells, CD4+ T cells, and resting natural killer cells. The negative association with naive CD4+ T cells was replicated in ECLIPSE. In the flow-cytometry study, an increase in CTLA4 on CD4+ T cells was positively associated with AE-COPDs. Conclusions: Individuals with COPD with lower circulating lymphocyte counts, particularly decreased CD4+ T cells, are more susceptible to AE-COPDs, including persistent exacerbations.

Decoding the Chronic Obstructive Pulmonary Disease (COPD) Puzzle: Investigating the Significance of Exacerbation Scores in Triage Decision-Making

Chronic obstructive pulmonary disease (COPD) is a complex disease pathology of the lungs that has a significant impact on global health. It has been a major contributor to global mortality and morbidity, with COPD exacerbations posing a substantial economic burden on the healthcare systems. Appropriate triaging of patients with COPD exacerbation is crucial to reduce the burden of hospitalization, especially in the intensive care unit (ICU). Understanding the significance of exacerbation scores in triage decision-making is essential for improving outcomes and optimizing patient care. To aid this triage decision-making, several scoring systems have been developed. This review article aims to discuss the different scores, including assessment of Confusion, Urea, Respiratory rate, Blood pressure, and Age (≥65 years) (CURB-65); Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF), Neutrophil to lymphocyte ratio (NLR); Platelet-lymphocyte ratio (PLR); Pneumonia severity index/Pneumonia Patient Outcomes Research Team (PSI/PORT); and elevated BUN, Altered mental status, Pulse, Age (>65 years) (BAP-65), and their role in triaging COPD exacerbations. Proper triaging allows for the appropriate allocation of resources and timely interventions based on severity. Further research and validation are needed to establish the optimal use and integration of these scores in clinical practice, particularly in ICU settings.

Prognostic Value of Neutrophil to Lymphocyte Ratio for Predicting 90-Day Poor Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective

This study aimed to evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) for poor outcomes within 90-day in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A retrospective study including 503 AECOPD patients was performed, and the subjects' clinical characteristics were collected. Binary logistic regression analysis was used to identify risk factors for 90-day poor outcomes in patients with AECOPD. Receiver-operating characteristic curves (ROC) and areas under the curves (AUC) were used to assess the ability of different biomarkers to predict the risk of 90-day mortality, readmission and re-exacerbation in patients with AECOPD.

Results

During the follow-up, 188 patients (38.4%) redeveloped exacerbations, 112 patients (22.9%) were readmitted, and 20 patients (4.1%) died directly resulted from COPD or COPD-related causes. Multivariate analysis demonstrated that age>72 years (OR: 14.817, 95% CI: 1.561-140.647), NLR>14.17 (OR: 9.611, 95% CI: 2.303-40.113), EOS<0.15% (OR: 8.621, 95% CI: 3.465-34.913) and BNP>2840ng/L (OR: 5.291, 95% CI: 1.367-20.474) at discharge were independent risk factors for 90-day mortality in AECOPD patients. NLR was the optimal biomarker for predicting 90-day mortality with an AUC of 0.802 (95% CI: 0.631-0.973). Using 14.17 as the critical value of NLR, the sensitivity was 76.7%, and the specificity was 88.9%. Compared with mortality, NLR had no significant advantage in predicting risk of short-term re-exacerbation (AUC=0.580, 95% CI:0.529-0.632, p=0.001) and readmission (AUC=0.555, 95% CI:0.497-0.614, p=0.045), with AUCs less than 0.6. In contrast, the predictive value of EOS (AUC=0.561, 95% CI:0.502-0.621, p=0.038) was slightly better than NLR in terms of readmission within 90 days. CRP did not serve as a well predictive biomarker for the risk of readmission and re-deterioration (p>0.05).

Conclusion

NLR is of great value in predicting the risk of poor outcomes, especially COPD associated mortality, in hospitalized patients with AECOPD within 90 days after discharge.

Predictive value of neutrophil-to-lymphocyte ratio and bilirubin levels in the readmission of acute exacerbation of chronic obstructive pulmonary disease

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.

Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study

The goal of this study was to investigate in-hospital mortality in patients suffering from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relative to the neutrophil to lymphocyte ratio (NLR) and to determine if there are gender disparities in outcome. Between February 26 and September 8, 2020, patients having SARS-CoV-2 infection were enrolled in this retrospective cohort research, which was categorized by NLR levels ≥9 and < 9. In total, 6893 patients were involved included of whom6591 had NLR <9, and 302 had NLR ≥9. The age of most of the patients in the NLR<9 group was 50 years, on the other hand, the age of most of the NLR ≥9 group patients was between 50 and 70 years. The majority of patients in both groups were male 2211 (66.1%). The ICU admission time and mortality rate for the patients with NLR ≥9 was significantly higher compared to patients with NLR <9. Logistic regression's outcome indicated that NLR ≥9 (odds ratio (OR), 24.9; 95% confidence interval (CI): 15.5–40.0; p < 0.001), male sex (OR, 3.5; 95% CI: 2.0–5.9; p < 0.001) and haemoglobin (HB) (OR, 0.95; 95% CI; 0.94–0.96; p < 0.001) predicted in-hospital mortality significantly. Additionally, Cox proportional hazards analysis (B = 4.04, SE = 0.18, HR = 56.89, p < 0.001) and Kaplan–Meier survival probability plots also indicated that NLR>9 had a significant effect on mortality. NLR ≥9 is an independent predictor of mortality(in-hospital) among SARS-CoV-2 patients.

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The main finding of this study is that NLR is an autonomous predictor of in-hospital mortality in patients with SARS-CoV-2.

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Fatality in SARS-CoV-2 patients with NLR >9 was 25 times higher than that in patients with NLR <9.

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Patients with NLR >9, the average length of ICU stay was higher.

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Mortality rate in males was high compared to females with NLR>9.

Risk Assessment of Death of Tumor-Related PTE by CAR Combined with DD Detection

Objective

To investigate the risk of death in patients with tumor-related PTE (pulmonary thromboembolism) detected by CAR (C-reactive protein/albumin ratio) combined with DD (D-dimer).

Methods

The peripheral hematology and coagulation-related indexes of 109 patients with tumor-related PTE diagnosed by PTCA were retrospectively analyzed, and the differences in relationship indexes between tumor-related PTE patients with good prognosis and poor prognosis were compared and analyzed. The receiver operating characteristic curve (ROC) was used to analyze the risk of death in patients with tumor-related PTE by CAR and DD.

Results

① The values of CAR and DD in the poor prognosis group were 3.90 ± 2.69 and 21.25 ± 21.20, respectively, which were significantly higher than those in the good prognosis group (1.66 ± 1.77, 9.53 ± 3.57) (P all <0.01). ② WBC, NE and SII in tumor-related PTE patients with poor prognosis were significantly higher than those in patients with good prognosis, while Hb in patients with poor prognosis was significantly lower than that in patients with good prognosis. ③ There was a significant positive correlation between CAR and DD (P=0.018). ④ The values of CAR and DD in the death group were 4.07 ± 2.42 and 19.65 ± 20.48, respectively, which were significantly higher than those in the survival group (1.94 ± 2.12, 11.52 ± 15.84) (P all<0.05). ⑤ The results of logistic regression analysis showed that both CAR (P=0.000) and DD (P=0.031) were independent prognostic factors in patients with tumor-related PTE. ⑥ CAR combined with DD had high sensitivity (77.8%) and specificity (83.5%), and the Youden index was 0.613. ⑦ The area under the receiver operating characteristic curve of CAR combined with DD was the largest (up to 0.806).

Conclusion

CAR and DD were highly expressed in patients with poor prognosis of tumor-related PTE. CAR combined with DD detection is helpful to improve the correct assessment of the risk of death in patients with tumor-related PTE.

Are Neutrophil-Lymphocyte, Platelet-Lymphocyte, and Monocyte-Lymphocyte Ratios Prognostic Indicators in Patients With Chronic Obstructive Pulmonary Disease in Intensive Care Units?

Background and objective

Chronic obstructive pulmonary disease (COPD) is a condition in which the expiratory airflow is restricted and is characterized by inflammation. Recently, inflammation-related biomarkers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) have been used to predict the prognosis in COPD. The aim of this study was to evaluate the role of biomarkers such as NLR, PLR, and MLR in COPD patients in intensive care and to examine the ability of these markers to predict the prognosis [length of stay in hospital (LOSH), duration of mechanical ventilation (MV), length of stay in ICU (LOS ICU), and mortality].

Methods

A total of 562 patients who were treated in the ICU between 2018 and 2019 were retrospectively reviewed. Among them, 369 were patients with COPD. We evaluated clinical data including patient demographics, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, LOS ICU, LOSH, duration of MV, as well as NLR, PLR, and MLR values. Data on patient deaths (30-day mortality) was obtained from the Death Notification System.

Results

Age, LOSH, CCI, and SOFA were found to predict mortality in COPD patients. In cases with mortality, age, inotropic use, MV duration, LOS ICU, APACHE II, CCI, SOFA, lymphocyte count, neutrophil count, platelet count, monocyte count, NLR, PLR, and MLR levels were statistically significantly higher than those in cases without mortality. There was a positive and low statistically significant relationship of NLR, PLR, and MLR with prognostic factors like MV duration, APACHE II scores, and SOFA scores.

Conclusion

The NLR, PLR, and MLR values may be used as prognostic indicators in COPD patients in intensive care. Although there are many studies endorsing the use of biomarkers such as NLR, PLR, and MLR as prognostic indicators, further comparative studies on this subject are still required to gain deeper insights into the topic.

Influence of disease severity, smoking status and therapy regimes on leukocyte subsets and their ratios in stable chronic obstructive pulmonary disease

INTRODUCTION

Blood cells are involved in systemic inflammation in chronic obstructive pulmonary disease (COPD). We aimed to assess differences in leukocyte subsets and their ratios between COPD patients and healthy individuals as well as their association with disease severity, smoking status and therapy in COPD.

MATERIAL AND METHODS

One hundred and nine patients in the stable phase of COPD and 95 controls participated in the study. After blood sampling, white blood cells (WBC), neutrophils (NEUTRO), monocytes (MO), lymphocytes (LY) and basophils (BA) were determined on a Sysmex XN-1000 analyser, and ratios were calculated afterwards.

RESULTS

White blood cells, NEUTRO, MO and BA were higher in COPD patients than in controls. Also, COPD patients had increased neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), monocyte to lymphocyte ratio (MLR), basophil to lymphocyte ratio (BLR), basophil to monocyte ratio (BMR) and monocyte/granulocyte to lymphocyte ratio (M/GLR). Smoking has an impact on leukocyte counts, with BA, BLR and BMR being higher in COPD smokers vs. ex-smokers. Patients with very severe COPD were distinguished from moderate COPD by NLR, dNLR and M/GLR. In addition, those parameters were associated with lung function and dyspnoea, and NLR and dNLR also with multicomponent COPD indices BODCAT and DOSE. Great potential of dNLR, NLR and M/GLR in identifying COPD patients was observed regarding their odds ratios (OR) of 5.07, 2.86, 2.60, respectively (p < 0.001). Common COPD therapy did not affect any of the parameters investigated.

CONCLUSIONS

Leukocyte subsets and their ratios could be implemented in COPD assessment, especially in evaluating disease severity and prediction.

Atrial electromechanical delay, neutrophil-to-lymphocyte ratio, and echocardiographic changes in patients with acute and stable chronic obstructive pulmonary disease

Background:

Atrial electromechanical delay (AEMD) is the time interval between the beginning of P wave on surface electrocardiography and starting of the late diastolic wave on tissue Doppler imaging. We investigated the prolongation of AEMD, echocardiographic changes, and correlation of these findings with neutrophil-to-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD).

Materials and Methods:

The study consisted of 105 (49 females and 56 males; mean age: 65.1 ± 9) patients with COPD exacerbation and 104 (21 females and 83 males; mean age: 64.8 ± 9.6) stable COPD outpatients. Demographics, body mass index, pulmonary function tests, and transthoracic echocardiography of the patients were evaluated. Echocardiography was performed in the first 6 h for stable COPD outpatients and in the first 24 h for COPD exacerbation patients. Diameters of right ventricle (RV), left ventricle (LV) and left atrium, aortic root diameters, left ventricular ejection fraction (LVEF), E_max, A_max, E_max/A_max, tricuspid annular plane systolic excursion (TAPSE), Ea, Aa, Ea/Aa, E_max/Ea, and tricuspid regurgitation velocity (TRV) were evaluated. AEMD measurements were obtained from lateral/tricuspid, lateral/mitral, and septal annulus from apical four-chamber views with tissue Doppler imaging and corrected for heart rate. Complete blood count including NLR was also assessed.

Results:

The mean age of patients in exacerbation period (65.1 ± 9) was higher than the stable group (64.8 ± 9.6). RV basal and mid diameters (P < 0.001), A_max (P < 0.001), Ea tricuspid (P = 0.040), Aa tricuspid (P < 0.001), TRV, and systolic pulmonary artery pressure (P < 0.001) were higher; TAPSE and tricuspid E_max/A_max (P < 0.001) were significantly lower in patients with COPD exacerbation. LV end-diastolic diameter (P = 0.002) and LVEF (P = 0.005), E_max/A_max mitral (P < 0.001), Ea/Aa mitral (P < 0.001), and Ea/Aa septal (P < 0.001) were significantly lower; A_max mitral (P = 0.002), Aa mitral (P < 0.001), Aa septal (P < 0.001), and systolic motion mitral (P = 0.011) were significantly higher in patients with exacerbation. AEMD lateral/tricuspid (P < 0.001), lateral/mitral (P < 0.001), and septal (P < 0.001) were significantly higher in patients with COPD exacerbation. Neutrophil and lymphocyte count (P < 0.001) and NLR (P = 0.003) were significantly higher in the acute group. A weak correlation of NLR with LV end-diastolic diameter (P = 0.003; r = 0.357), E_max/Ea mitral (P = 0.019; r = 0.285), E_max tricuspid (P = 0.045; r = −0.244), and systolic motion septal (P = 0.003; r = 0.352) was detected in patients with stable COPD.

Conclusion:

In COPD exacerbation patients, prolongation of AEMD intervals was determined. Acute period of COPD may trigger atrial dysrhythmias including atrial fibrillation and flutter, multifocal atrial tachycardia, premature beats, and both systolic and diastolic dysfunctions frequently.

Evaluation of Prognosis and Risk of Death by Neutrophil/Lymphocyte Ratio, C-Reactive Protein/Albumin Ratio and Plasma D-Dimer in Patients with Pulmonary Thromboembolism

Objective

To investigate the relationship between neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, plasma D-dimer and prognosis in patients with pulmonary thromboembolism, and to evaluate the risk of death.

Methods

We retrospectively analyzed peripheral hematology and coagulation-related indicators of 362 pulmonary thromboembolism patients and 32 normal people, and the differences between the patients and control group and between good and poor prognosis groups were compared. And we analyzed and compared separate detection and combined detection of neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer on the efficiency of risk of death in patients.

Results

① Neutrophil/lymphocyte ratio of pulmonary thromboembolism patients was 8.96±1.94, significantly higher than that of control group 1.76±0.53 (t=2.4281, P<0.05). C-reactive protein/albumin ratio was 2.13±2.08, significantly higher than 0.03±0.01 in control group (t=20.7736, P<0.01). D-dimer was 9.69±8.61mg/L, significantly higher than 0.20±0.11mg/L in control group (t=3.0066, P<0.01). ② Hemoglobin, lymphocyte, albumin and lymphocyte/monocyte ratio in patients with good prognosis were significantly lower than those in poor prognosis group, while white blood cell, C-creative protein, neutrophil, C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio and D-dimer were significantly lower than those in poor prognosis group (P all <0.05). ③ Regression analysis showed that neutrophil/lymphocyte ratio (P=0.007), C-reactive protein/albumin ratio (P=0.010) and D-dimer (P=0.003) were independent prognostic factors for pulmonary thromboembolism. ④ In assessing the risk of death of patients, D-dimer alone had the highest sensitivity (93.1%), and C-reactive protein/albumin ratio alone had the highest specificity (68.8%). The combined detection of these three indicators had higher sensitivity (86.2%) and higher specificity (67.6%) at the same time. ⑤ The area under receiver operating characteristic curve for combined detection of neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer was the largest (up to 0.821).

Conclusion

Patients with pulmonary thromboembolism highly expressed in neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer. The combined detection of these three indicators can improve the assessment efficacy of the risk of death in patients with pulmonary thromboembolism.

Nine-Year Follow-Up of Interleukin 6 in Chronic Obstructive Pulmonary Disease - Complementary Results from Previous Studies

Background

Systemic manifestations of chronic obstructive pulmonary disease (COPD) are related to increased systemic inflammatory process; however, it is not entirely clear how much they are related and how the systemic inflammation, in particular interleukin-6 (IL-6), is associated with exacerbation and mortality risk.

Objective

To evaluate the role of IL-6 in COPD patients over nine years.

Study Design and Methods

A total of 133 COPD patients were assessed at baseline between 2004 and 2006 and reassessed after three and nine years through clinical evaluation, comorbidities, hematological blood count and IL-6 analysis.

Results

After nine years, 19 patients lost the follow-up and were not possible to identify the date of death of four patients; 12 refused to participate and 1 could not be involved due to recurrent exacerbations. Therefore, 33 patients were included in the reassessment after nine years of follow-up and 92 patients were included in the Cox mortality analysis with IL-6 as a time-dependent covariate. Regarding the inflammatory profile, in patients who survived after nine years, there was a significant increase in IL-6 [0.4 (0.2–0.8) vs 5.7 (3.4–11) pg/mL; p < 0.001] and reduction in lymphocyte count [2.1 (1.6–2.4) vs 1.4 (1.2–2.1)10^9/L; p < 0.01] with an increase in the neutrophil/lymphocyte ratio (2.0 ± 0.7 vs 2.7 ± 1.2; p = 0.003). The Cox mortality model did not show a statistical significance influence of IL-6 assessed during the follow-up.

Conclusion

There was a progressive increase in IL-6 during the follow-up, however, without influence on mortality.

Neutrophil-to-lymphocyte ratio, blood eosinophils and COPD exacerbations: a cohort study

BACKGROUND

Blood neutrophil-to-lymphocyte ratio (NLR) and blood eosinophils (B-Eos) are emerging biomarkers in COPD. This study examined whether they could predict acute exacerbations of COPD (AECOPDs), and determined their longitudinal stability.

METHODS

In this closed cohort study, Swedish subjects with spirometry-verified COPD attended three yearly visits in a stable phase of the disease. Blood cell counts, spirometry and questionnaire-assessed AECOPD-history (worsening of COPD leading to an unscheduled visit and/or use of antibiotics and/or oral corticosteroids) were collected at each visit.

RESULTS

Of 466 included subjects 57% were female. Baseline mean±sd forced expiratory volume in 1 s was 58±17% predicted. High NLR (≥3.0) was more common in subjects with previous AECOPDs than in those without (33.5% versus 20.4%, p=0.002). In two-level mixed-effects logistic regression models adjusted for confounders, NLR as a continuous variable (OR 1.20, 95% CI 1.04-1.38) and B-Eos ≥300 cells·µL-1 (OR 1.54, 95% CI 1.06-2.24) were associated with future AECOPDs. In 386 subjects with blood cell data available at all three visits, the intraclass correlation coefficient for NLR was 0.61 (95% CI 0.56-0.66) and for B-Eos 0.69 (95% CI 0.64-0.73). NLR was persistently ≥3.0 in 10.6% and B-Eos was persistently ≥300 cells·µL-1 in 15.3%.

CONCLUSIONS

Stable phase NLR and B-Eos were associated with future AECOPDs. NLR on its own is probably not useful to predict AECOPDs but might be included in a risk scoring index. A minority of subjects with COPD had persistently elevated stable-phase NLR or B-Eos, and the biomarkers showed fair longitudinal reliability.

Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). CS exposure causes an imbalance favoring pro- over antioxidants (oxidative stress), leading to transcription factor activation and increased expression of inflammatory mediators and proteases. Different cell types, including macrophages, epithelial cells, neutrophils, and T lymphocytes, contribute to COPD pathophysiology. Alteration in cell functions results in the generation of an oxidative and inflammatory microenvironment, which contributes to disease progression. Current treatments include inhaled corticosteroids and bronchodilator therapy. However, these therapies do not effectively halt disease progression. Due to the complexity of its pathophysiology, and the risk of exacerbating symptoms with existing therapies, other specific and effective treatment options are required. Therapies directly or indirectly targeting the oxidative imbalance may be promising alternatives. This review briefly discusses COPD pathophysiology, and provides an update on the development and clinical testing of novel COPD treatments.

Alveolar macrophage transcriptomic profiling in COPD shows major lipid metabolism changes

Background

Immune cells play a major role in the pathogenesis of COPD. Changes in the distribution and cellular functions of major immune cells, such as alveolar macrophages (AMs) and neutrophils are well known; however, their transcriptional reprogramming and contribution to the pathophysiology of COPD are still not fully understood.

Method

To determine changes in transcriptional reprogramming and lipid metabolism in the major immune cell type within bronchoalveolar lavage fluid, we analysed whole transcriptomes and lipidomes of sorted CD45⁺Lin⁻HLA-DR⁺CD66b⁻Autofluorescence^hi AMs from controls and COPD patients.

Results

We observed global transcriptional reprogramming featuring a spectrum of activation states, including pro- and anti-inflammatory signatures. We further detected significant changes between COPD patients and controls in genes involved in lipid metabolism, such as fatty acid biosynthesis in GOLD2 patients. Based on these findings, assessment of a total of 202 lipid species in sorted AMs revealed changes of cholesteryl esters, monoacylglycerols and phospholipids in a disease grade-dependent manner.

Conclusions

Transcriptome and lipidome profiling of COPD AMs revealed GOLD grade-dependent changes, such as in cholesterol metabolism and interferon-α and γ responses.

AMs from COPD patients undergo GOLD grade-specific transcriptional reprogramming and acquire a complex activation profile. Among the observed changes are gene programmes involved in lipid metabolism that translate into alterations in the AM lipidome.https://bit.ly/3sYAqgd

Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin's adjunct role

How to identify the optimum switch point of sequential invasive and noninvasive ventilation is the focus of clinical attention on the patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by acute respiratory failure (ARF). This study aims to explore the clinical significance of taking the change rate of procalcitonin (PCT) as identifying the timing of weaning on the mechanical ventilation for the patients of AECOPD followed by ARF as a complication. There were altogether 140 patients of AECOPD complicated with ARF, who were randomly selected and divided into a study group and a control group respectively. A change rate of serum PCT level exceeding 50% was taken as the switch point selection of tracheal intubation removal for the patients of the study group, while the ‘pulmonary infection control (PIC) window’ was done for those in the control group. With CRP, IL-6, TNF-a, PaCO_2, PaO_2, and Lac having been detected before and after treatment to them all, clinical indexes were obtained and compared between these two groups. The CRP, TNF-a, and IL-6 levels of the patients in the study group after treatment (p < 0.05) were lower than those in the control group. There was no significant difference in PaCO_2, PaO_2, and Lac between these two groups before and after treatment (p > 0.05). Even so, some other indexes available for the study group of patients were found to be lower than those for the control group (p < 0.05) in the following aspects: duration of invasive ventilation support, total time of mechanical ventilation support, incidence rate of ventilator-associated pneumonia, 48-hour reintubation rate, incidence rate of upper gastrointestinal bleeding, hospitalization time of critical respiratory illness, total hospitalization time, RICU treatment cost, total treatment cost, and mortality. It is preferable to take the change rate of PCT level exceeding 50% as the switch point of weaning time in sequential mechanical ventilation rather than the PIC window.

Abbreviations

AECOPD: acute exacerbation of chronic obstructive pulmonary disease; ARF: acute respiratory failure; PCT: procalcitonin; PaO₂: the oxygen partial pressure; PaCO₂: the partial pressure of carbon dioxide; TNF-a: serum tumor necrosis factor-a; IL-6: interleukin-6; CRP: serum C-reactive protein; PIC window: pulmonary infection control window; RICU: respiration and intensive care unit

The Neutrophil/Lymphocyte Ratio Could Predict Noninvasive Mechanical Ventilation Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study

Purpose

To determine the effectiveness of neutrophil/lymphocyte ratio (NLR), compared to traditional inflammatory markers, for predicting noninvasive mechanical ventilation (NIMV) failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.

Patients and Methods

We conducted this retrospective observational study including 212 AECOPD patients who required NIMV during hospitalization from January 2015 to December 2020 in the department of respiratory and critical care medicine of Beijing Chao-Yang Hospital (west campus). We reviewed the medical record to determine if NIMV succeeded or failed for each patient, and compared NLR with traditional markers (leukocyte, C-reactive protein [CRP] and procalcitonin [PCT]) between NIMV failure and NIMV success group. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analysis were used to assess the accuracy of these markers for predicting NIMV failure.

Results

A total of 38 (17.9%) patients experienced NIMV failure. NLR was a more sensitive biomarker to predict NIMV failure (AUC, 0.858; 95% CI 0.785-0.931) than leukocyte counts (AUC, 0.723; 95% CI 0.623-0.823), CRP (AUC, 0.670; 95% CI 0.567-0.773) and PCT (AUC, 0.719; 95% CI 0.615-0.823). There was statistically positive correlation between NLR and leukocytes count (r=0.35, p<0.001), between NLR and CRP (r=0.258, p<0.001), between NLR and PCT (r=0.306, p<0.001). The cutoff value of NLR to predict NIMV failure was 8.9 with sensitivity 0.688, specificity 0.886 and diagnostic accuracy 0.868. NLR>8.9 (odds ratio, 10.783; 95% CI, 2.069-56.194; P=0.05) was an independent predictor of NIMV failure in the multivariate logistic regression model.

Conclusion

NLR may be an effective marker for predicting NIMV failure in AECOPD patients, and the patients with NLR>8.9 should be handled with caution since they are at higher risk of NIMV failure and require intubation. Further study with a larger sample size and with more data is necessary to confirm our study.

Prognostic Value of Neutrophil:Lymphocyte and Platelet:Lymphocyte Ratios for 28-Day Mortality of Patients with AECOPD

Objective

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common cause of hospitalization and death among COPD patients. Clinicians are seeking simple, inexpensive, and easily obtained biomarkers for prognostic evaluation. The aim of this study was to evaluate the association of the neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR) and lymphocyte:monocyte ratio (LMR) with 28-day mortality and assess the clinical prognostic utility of the NLR, PLR, and LMR in patients with AECOPD.

Methods

A retrospective study was conducted from January 2017 to April 2020 at Ningbo First Hospital. Clinical characteristics, NLR, PLR, LMR, serum levels of CRP, and other data were collected. Relationships between the NLR/PLR/LMR and CRP were evaluated with Pearson’s correlation test. Receiver-operating characteristic curves and area under the curve were used to assess the ability of NLR/PLR/LMR to predict 28-day mortality in patients with AECOPD. Optimal cutoff values were determined by the Youden index. Univariate and multivariate logistic regression analysis were used to identify risk factors for 28-day mortality in patients with AECOPD.

Results

By reviewing the medical case records, we collected 533 cases diagnosed with AECOPD for analysis. Death had occurred in 48 (9%) patients within 28 days. Univariate analysis identified age, smoking history, FEV₁% predicted, neutrophil count, lymphocyte count, NLR, PLR, CRP and blood-urea nitrogen as being associated with increased 28-day mortality. Multivariate analysis demonstrated that elevated NLR and PLR were significantly associated with death at 28 days. Receiver-operating characteristic analysis showed that the NLR had the highest area under the curve (0.801), with optimal cutoff of 6.74, sensitivity of 82.54%, and specificity of 71.38%. At a cutoff of 203.6, the corresponding sensitivity, specificity, and area under the curve of the PLR were 76.86%, 65.27%, and 0.75. The LMR failed to show prognostic significance.

Conclusion

Our results indicated that the NLR and PLR were associated with 28-day mortality in patients with AECOPD. These ratios may serve as prognostic biomarkers for short-term mortality in patients hospitalized with AECOPD.

Neutrophil-to-Lymphocyte Ratio Predicts High-Risk Explant Features and Waitlist Survival But Is Not Independently Associated With Recurrence or Survival Following Liver Transplantation for Hepatocellular Carcinoma

We assessed the prognostic significance and the clinical stability of the neutrophil-to-lymphocyte ratio (NLR) before liver transplantation (LT) in a large cohort of patients with hepatocellular carcinoma (HCC) from a region with a long waitlist time. A high preoperative NLR ≥5 has been reported to predict poor outcomes following LT for HCC, and the NLR has been incorporated into several prognostic models. We evaluated 758 patients with HCC with Model for End-Stage Liver Disease exceptions and listed for LT from 2002 to 2015 at a single LT center, of which 505 underwent LT and 253 dropped out before LT. The NLR was collected in all patients at LT and, if available, between 15 and 90 days before LT (NLR2) or at dropout. An NLR ≥5 was associated with microvascular invasion (MVI), poorer tumor differentiation, and more advanced pathology on explant. Patients with an NLR ≥5 exhibited no differences in alpha-fetoprotein, tumor burden at listing, or number of locoregional therapies compared with patients with an NLR <5. After a median post-LT follow-up of 4.7 years, overall survival and recurrence rates were similar for patients with an NLR ≥5 versus patients with an NLR <5. The NLR changed frequently, and 47% of patients whose NLR2 was ≥5 had an NLR <5 by LT. The NLR was ≥5 in 47.6% of patients at dropout compared with 14.9% of patients undergoing LT. Although the NLR at LT correlated with MVI and tumor stage at explant, the NLR did not predict post-LT survival or HCC recurrence. The NLR appeared to be a relatively unstable inflammatory marker during the immediate 3 months before LT for HCC.

Biomarkers as a Prognostic Factor in COPD Exacerbation: A Cohort Study

The acute exacerbations of COPD (AECOPD) are one of the main causes of hospitalization and morbimortality in the adult population. There are not many tools available to predict the clinical course of these patients during exacerbations. Our goal was to estimate the clinical utility of C Reactive Protein (CRP), Mean Platelet Volume (MPV), eosinophil count and neutrophil/lymphocyte ratio (NLR) as in-hospital prognostic factors in patients with AECOPD. A prospective cohort study was conducted in patients who consulted three reference hospitals in the city of Medellín for AECOPD and who required hospitalization between 2017 and 2020. A multivariate analysis was performed to estimate the effect of biomarkers in the two primary outcomes: the composite outcome of in-hospital death and/or admission to the ICU and hospital length-of-stay. A total of 610 patients with a median age of 74 years were included; 15% were admitted to the ICU and 3.9% died in the hospital. In the multivariate analysis adjusted for confounding variables, the only marker significantly associated with the risk of dying or being admitted to the ICU was the NLR > 5 (OR: 3; CI95%: 1.5; 6). Similarly, the NLR > 5 was also associated to a lower probability of being discharged alive from the institution (SHR: 0.73; CI95%: 0.57; 0.94) and, therefore, a longer hospital stay. It was found that a neutrophil/lymphocyte ratio greater than 5 is a strong predictor of mortality or ICU admissions and a longer hospital stay in patients hospitalized with AECOPD.

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.

Catching "Early" COPD - The Diagnostic Conundrum

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Despite this, there has been little progress so far in terms of disease-modifying therapies over the last few decades and this is in part due to poor understanding of the definition and mechanisms surrounding early disease before it becomes established and increasingly complex. In this review, the nuances and difficulty in defining early disease in COPD are discussed. There are clear benefits in identifying patients early; however, usually diagnosis is made in the presence of significant lung damage. We consider what can be learned of early disease from COPD studies and highlight the lack of inclusion of young smokers (who may be at risk of COPD) or those with mild disease. We discuss promising clinical measures that are being used in an effort to detect early disease. These include symptom assessment, lung physiology measures and computed tomography (CT) imaging modalities. There is emerging evidence for the role of neutrophils and their proteinases in early COPD. This may form an important biomarker to investigate the pathophysiological processes of early COPD. Given the importance of the early disease, it is recommended that future COPD studies focus on capturing the earliest manifestations of disease, to understand the initiating mechanisms and to identify novel treatment targets.

Neutrophil-to-Lymphocyte Ratio Predicts Clinical Outcome of Severe Acute Exacerbation of COPD in Frequent Exacerbators

Purpose

Frequent exacerbators are a specific phenotype of chronic obstructive pulmonary disease (COPD), whose clinical characteristics and prognostic biomarkers during severe acute exacerbation (AECOPD) have not yet been fully elucidated. The aim of this study was to investigate the clinical features of severe AECOPD in frequent exacerbators and explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for outcome in this phenotype during severe exacerbation.

Patients and Methods

A total of 604 patients with severe AECOPD were retrospectively included in the study. Subjects were defined as frequent exacerbators if they experienced two or more exacerbations in the past year. Clinical characteristics and worse outcome (ICU admission, or invasive ventilation, or in-hospital mortality) during severe AECOPD were compared between frequent exacerbators and non-frequent ones. Furthermore, the relationship between NLR and worse outcome in frequent exacerbators was analyzed using logistic regression and receiver operating characteristic (ROC).

Results

Among 604 patients with severe AECOPD, 282 (46.69%) were frequent exacerbators and 322 (53.31%) were non-frequent exacerbators. Compared with the non-frequent ones, frequent exacerbators presented higher levels of NLR (5.93 [IQR, 3.40–9.28] vs 4.41 [IQR, 2.74–6.80]; p<0.001), and more worse outcome incidence (58 [20.57%] vs 38 [11.80%]; p=0.003). Moreover, among the frequent exacerbators, NLR levels in the patients with worse outcome were much higher than in those without worse outcome (11.09 [IQR, 7.74–16.49] vs 5.28 [IQR, 2.93–7.93]; p<0.001). Increased NLR was significantly associated with a higher risk of worse outcome in frequent exacerbators (OR, 1.43; 95% CI, 1.28–1.64; p<0.001). Furthermore, ROC analysis revealed that a cut-off value of 10.23, NLR could predict worse outcome of severe AECOPD in frequent exacerbators (sensitivity 62.1%, specificity 92.0%, AUC 0.833).

Conclusion

Frequent exacerbators exhibited an increased level of NLR and a higher proportion of worse outcome during severe AECOPD. NLR is expected to be a promising predictive biomarker for the prognosis of severe AECOPD in frequent exacerbators.

Relationship between platelet/lymphocyte ratio and prognosis of patients with septic acute kidney injury: A pilot study

BACKGROUND

To explore the potential role of the platelet/lymphocyte ratio (PLR) as a prognostic marker in septic patients with acute kidney injury (AKI) and to provide theoretical evidence for the epidemiological study of the prognosis of patients with septic AKI in its early stage.

METHODS

A pilot study was conducted. A logistic regression analysis was conducted to screen the risk factors, and the selected factors were performed using multiple logistic regression analysis; a Receiver Operating Characteristic curve was used to determine the optimal cutoff value of the PLR and then to calculate the sensitivity and specificity of the PLR ratio.

RESULTS

Mechanical ventilation, platelet count, PLR, and arterial blood lactate concentration have a correlation with sepsis (p < 0.05). An elevated PLR is significantly associated with a worse prognosis of sepsis-induced AKI (higher mortality).

CONCLUSION

The PLR might be an effective factor in predicting a worse prognosis of septic AKI patients.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Inflammatory Markers in Patients With Welders' Lung Disease

OBJECTIVE

To investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with welders' lung disease (PWLD) and its relation with pulmonary function parameters.

METHODS

One hundred sixteen male PWLD and 118 healthy non-exposed individuals were recruited. Pulmonary function tests (PFTs), complete blood count, erythrocyte sedimentation rate (SED), c-reactive protein (CRP), NLR and PLR of both groups were retrospectively analyzed.

RESULTS

NLR, PLR, WBC, ESR, and CRP were significantly higher in PWLD compared to controls (all P < 0.001). All PFTs, except for FEV1/FVC, significantly decreased in PWLD compared to controls as. NLR correlated positively with ESR (r = 0.241 and P < 0.001).

CONCLUSION

Our results show that NLR and PLR can be considered as new inflammatory markers in PWLD with their cheap, fast and easily measurable feature with routine blood count analysis.

The correlational study about neutrophil-to-lymphocyte ratio and exercise tolerance of chronic obstructive pulmonary disease patients

To study the relationship between neutrophil to lymphocyte ratio (NLR) and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD).235 patients with COPD were selected as the study subjects. Complete blood count, C reactive protein (CRP), pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council, the COPD assessment test, and clinical COPD questionnaire were tested. Heart rate, oxygen saturation, and Borg scale were tested before or after 6MWD test.By the median of NLR, the subjects were divided into 2 groups, NLR ≥4.5 group and NLR <4.5 group. The white blood cell count (WBC), CRP and deoxygenation saturation in the NLR ≥4.5 group were higher than those in the NLR <4.5 group, while the age, body mass index (BMI), 6MWD, and heart rate variation were lower than those in the NLR <4.5 group. CRP, WBC, and deoxygenation saturation had positive effects on NLR, BMI, 6MWT, and heart rate variation had negative effects on NLR. The Pearson correlation analysis showed NLR was positively correlated with WBC, CRP, BMI index, 6MWT, and deoxygenation saturation, while it was negatively correlated with BMI and heart rate variation.NLR might associate with exercise tolerance and cardiorespiratory reserve of COPD patients, and could be used as an indicator of muscle function in COPD patients.

Association of Neutrophil to Lymphocyte Ratio With Pulmonary Function in a 30-Year Longitudinal Study of US Veterans

Importance

Chronic obstructive pulmonary disease (COPD) is a critical public health burden. The neutrophil to lymphocyte ratio (NLR), an inflammation biomarker, has been associated with COPD morbidity and mortality; however, its associations with lung function decline and COPD development are poorly understood.

Objective

To explore the associations of NLR with lung function decline and COPD risks.

Design, Setting, and Participants

This longitudinal cohort study included white male veterans in the US with more than 30 years of follow-up to investigate the associations of NLR with lung function, COPD, and hypomethylation of cg05575921, the top DNA methylation marker of lung function changes in response to tobacco smoking. This study included 7466 visits from 1549 participants, each examined up to 13 times between 1982 and 2018. A subgroup of 1411 participants without COPD at baseline were selected to analyze the association of NLR with incident COPD. Data were analyzed from September 2019 to January 2020.

Exposures

The primary exposure was NLR, which was estimated using automated whole blood cell counts based on a blood sample collected at each visit. The methylation level of cg05575921 was measured in blood DNA from a subgroup of 1228 visits.

Main Outcomes and Measures

The outcomes of interest were lung function, measured as forced respiratory volume in the first second (FEV1) in liters, forced vital capacity (FVC) in liters, percentage of FVC exhaled in the first second (FEV1/FVC), and maximal midexpiratory flow rate (MMEF) in liters per minute and COPD status, defined as meeting the Global Initiative for Chronic Obstructive Lung Diseases stage II (or higher) criteria. Both outcomes were measured as each visit.

Results

Among 1549 included men (mean [SD] age, 68.3 [9.3] years) with 7466 visits from 1982 to 2018, a 1-unit increase in NLR was associated with statistically significant mean (SE) decreases of 0.021 (0.004) L in FEV1, 0.016 (0.005) L in FVC, 0.290% (0.005) L in FVC, 0.290% (0.065%) in FEV1/FVC, and 3.65 (0.916) L/min MMEF. Changes in NLR up to approximately 10 years were associated with corresponding longitudinal changes in lung function. Furthermore, this increase in NLR was associated with 9% higher odds of COPD (odds ratio, 1.09 [95% CI, 1.03-1.15]) for all visits and 27% higher risk of incident COPD (odds ratio, 1.07 [95% CI, 1.07-1.51]) for participants without COPD at baseline. Additionally, a 1-unit increase in NLR was associated with a mean (SE) decrease of 0.0048 (0.0021 in cg05575921 hypomethylation, which may mediate the adverse association of NLR-related inflammation on lung function.

Conclusions and Relevance

These findings suggest that NLR may be a clinically relevant biomarker associated with high risk of lung function impairment and COPD alone or in combination with DNA methylation profiles.

Serum Biomarkers in Patients with Stable and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Comparative Study

BACKGROUND

Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD.

METHODS

Stable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups.

RESULTS

HB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1.

CONCLUSIONS

Our study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.

Analysis of the level of selected parameters of inflammation, circulating immune complexes, and related indicators (neutrophil/lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with obstructive diseases

Introduction

Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder of the airways. An important element of COPD assessment is the evaluation of immune mechanisms involved in non-specific and specific response to ongoing inflammation.

Aim of the study

To evaluate the level of selected inflammatory and immunological parameters in patients with COPD, including C-reactive protein (CRP) and circulating immune complexes (CIC), as well as CRP/CIC index.

Material and methods

The study group consisted of 49 patients with obstructive pulmonary diseases (COPD, asthma, and asthma-COPD overlap syndrome) hospitalised in the Department of Pulmonary Diseases, Kuyavian-Pomeranian Pulmonology Centre in Bydgoszcz. Patients with COPD were divided into two subgroups, taking into account the severity of the disease according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD; stages B and D). The control group consisted of 30 healthy persons. Levels of CIC were determined by the method of Hasková, and the concentration of CRP in serum by the standard immunoturbidimetric method.

Results

The median values of examined parameters (neutrophils, lymphocytes, platelets, neutrophil/lymphocyte ratio – NLR, platelet/lymphocyte ratio – PLR, CRP, CIC, and CRP/CIC index) were significantly higher among patients with obstructive diseases than in the control group. A tendency towards higher lymphocyte count, CRP, and CRP/CIC index in COPD stage D, compared to stage B, was observed.

Conclusions

Based on our results, we suggest that the role of non-specific inflammatory mechanisms may increase in more advanced COPD stages (D), compared to less advanced stages (B).

The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease

OBJECTIVE

Neutrophil to lymphocyte ratio (NLR) is considered as an inflammatory biomarker for clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). We aimed to conduct a meta-analysis to evaluate the prognostic values of NLR for the exacerbation and mortality in patients with COPD.

METHODS

We searched the database of Cochrane Central Register of Controlled Trials, EMBASE, and PubMed, before September 2017. The eligible studies were retrieved by 2 authors independently following the criteria. The pooled odds ratios (ORs) of included studies were used to evaluate the prognostic values of NLR. Subgroup analyses were conducted to make the results more accurate.

RESULTS

Nine studies with 5140 patients were enrolled in this analysis. The high NLR was associated with higher risk of exacerbation (OR: 3.81, 95% confidence interval [CI]: 1.20-12.13, P = .02) and mortality (OR: 2.60, 95% CI: 1.48-4.57, P < .01). By subgroup analysis, high NLR could predict the mortality in patients >70 years (OR: 2.16, 95% CI: 1.17-3.98, P = .01) but not in patients <70 years (OR: 4.08, 95% CI: 0.91-18.24, P = .07), and had a higher predictive ability in Asian group (OR: 3.64, 95% CI: 1.87-7.08, P < .01) than Eurasia group (OR: 1.82, 95% CI: 1.43-2.32, P < .01). In addition, high NLR could predict the short-term mortality (OR: 2.70, 95% CI: 1.10-6.63, P = .03) and the long-term mortality (OR: 2.61, 95% CI: 1.20-5.65, P = .02).

CONCLUSIONS

The NLR may be an independent predictor for incidence of exacerbation in patients with COPD. In addition, high NLR may be associated with higher mortality in patients with COPD, especially for Asian and the patients with higher mean NLR.

Neutrophil to Lymphocyte Ratio is a Predictive Factor of Malignant Potential for Intraductal Papillary Mucinous Neoplasms of the pancreas

Intraductal papillary mucinous neoplasms (IPMNs) are cystic neoplasms with the potential for progression to pancreatic cancer. Accurate prediction of the malignant potential is challenging and a proper treatment strategy has not been well established. Preoperative neutrophil-to-lymphocyte ratio (NLR) is a biomarker of the malignant potential in patients with several types of malignancy. We explored malignant potential in patients with IPMN. The present study included 56 patients aged of 73 ± 9 years (mean ± standard deviation) who underwent curative resection for IPMN from 1996 to 2017. We analyzed the relationship between the characteristics including NLR and malignant component for predicting pathological results. The nonmalignant IPMN group (N = 21) included patients with low-grade dysplasia (LGD) and intermediate-grade dysplasia (IGD), and the malignant IPMN group (N = 35) included patients with high-grade dysplasia (HGD) and invasive carcinoma. In a univariate analysis, NLR ⩾ 2.2 (P = .001), prognostic nutritional index (PNI) < 45 (P = .016), CA 19-9 > 37 U/mL (P = .039), and cystic diameter ⩾ 30 mm (P = .010), and mural nodule (P = .010) were significantly different between the malignant IPMN and the nonmalignant IPMN groups. Multivariate analysis showed that high NLR (⩾2.2) (odds ratio 9.79; 95% confidence interval: 2.06-45.6), cystic diameter ⩾ 30 mm (4.65; 1.14-18.9), and mural nodule (4.91; 1.20-20.1) were independently predictive of malignant IPMN. These results suggest that preoperative NLR is a useful predictive biomarker for evaluating malignant potential in patients with IPMN.1

[Clinical significance of peripheral blood neutrophil-lymphocyte ratio and platelet- lymphocyte ratio in patients with asthma]

OBJECTIVE

To investigate the changes of peripheral blood neutrophil-lymphocyte ratio (NLR) and platelet- lymphocyte ratio (PLR) in patients in acute stage of bronchial asthma and their clinical significance.

METHODS

A total of 262 patients with acute asthma, including 97 critical and 175 non-critical patients, were recruited from our hospital between January, 2013 and May, 2016, with 130 healthy individuals as the control group. The absolute neutrophil count, absolute lymphocyte count, platelet, NLR and PLR were compared among different groups, and their diagnostic values were evaluated using the area under the receiver-operating characteristic (ROC) curve.

RESULTS

The absolute neutrophil count, absolute lymphocyte count, PLR and NLR (P<0.0001), but not platelet count (P=0.971), differed significantly among the 3 groups. The absolute lymphocyte count was significantly lower while the absolute neutrophil count, NLR and PLR were significantly higher in asthmatic patients in critical condition than in patients in non-critical condition and the control subjects (P<0.0001), and these parameters showed no significant differences between latter two groups (P>0.05). The areas under the curve of absolute neutrophil count, absolute lymphocyte count, NLR and PLR for the diagnosis of acute exacerbation of bronchial asthma were 0.802, 0.784, 0.873 and 0.795, respectively (all P<0.01); the optimal cut-off value of NLR was 2.58 for the diagnosis with a sensitivity of 82.8% and a specificity of 81.1%.

CONCLUSIONS

Peripheral blood NLR and PLR are increased in asthmatic patients, and their variations offer assistance in the diagnosis and assessment of bronchial asthma.

Immunodeficiency in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD), characterized by progressive airway inflammation and irreversible airflow limitation, leads to serious decline in life quality. The acute exacerbation of COPD (AECOPD) results in high healthcare costs as well as a significant mortality rate. The most common cause of acute exacerbation is infection. Immune deficiency, which induces dysfunction of anti-infection, plays an important role in the pathogenesis of acute exacerbation. As described in this review, the immune dysfunction in patients with AECOPD can be a major focus of efforts to therapeutic strategy.

Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review

COPD is characterized by a pulmonary and systemic inflammatory process. Several authors have reported the elevation of multiple inflammatory markers in patients with COPD; however, their use in routine clinical practice has limitations. The neutrophil-to-lymphocyte ratio (NLR) is a useful and cost-effective inflammatory marker derived from routine complete blood count. We performed a systematic literature review using the PRISMA statement. Twenty-two articles were included, recruiting 7,601 COPD patients and 784 healthy controls. Compared with controls, COPD patients had significantly higher NLR values. We found a significant correlation between the NLR and clinical/functional parameters (FEV₁, mMRC, and BODE index) in COPD patients. Elevation of the NLR is associated with the diagnosis of acute exacerbation of COPD (pooled data propose a cut-off value of 3.34 with a median sensitivity, specificity, and area under the curve of 80%, 86%, and 0.86, respectively). Additionally, increased NLR is also associated with the diagnosis of a bacterial infection in exacerbated patients, with a cut-off value of 7.30, although with a low sensitivity and specificity. The NLR is an independent predictor of in-hospital and late mortality after exacerbation. In conclusion, the NLR could be a useful marker in COPD patients; however, further studies are needed to better identify the clinical value of the NLR.