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

Biomarkers (NLR, PLR, SII) for Frequent COPD Exacerbations: Diagnostic and Clinical Management Implications in a Retrospective Study

Objective

To evaluate the diagnostic and predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for frequent exacerbations of chronic obstructive pulmonary disease (AECOPD), and to develop a risk stratification scoring system to optimize clinical management in resource-limited healthcare settings.

Patients and Methods

This retrospective observational study enrolled 16,849 AECOPD patients, categorized into frequent exacerbators (≥2 exacerbations/year, n=3,488) and non-frequent exacerbators (<2 exacerbations/year, n=13,361). Comparative analyses of clinical characteristics and inflammatory biomarkers (NLR, PLR, SII, CRP, PCT) were conducted. Spearman correlation, receiver operating characteristic (ROC) curve analysis, and binary logistic regression were employed to assess biomarker performance. A risk scoring system was developed using odds ratios (OR) and regression coefficients (β) of NLR and PLR.

Results

The frequent exacerbators group exhibited significantly higher median NLR (6.71 vs 5.10, P < 0.001), mean PLR (239 ± 204 vs 218 ± 195, P < 0.001), and median SII (1,137.48 vs 847.54, P < 0.001). NLR, PLR and SII showed strong positive correlations with CRP and PCT (P < 0.001). ROC analysis identified NLR (specificity = 84.1%) and PLR (sensitivity = 55%) as optimal diagnostic indicators. Regression analysis confirmed NLR and PLR as independent risk factors for frequent exacerbations. The risk stratification system categorized patients into low-risk (<290 points; annual exacerbation rate 17%), intermediate-risk (290-768 points; 19.1%), and high-risk (>768 points; 23.4%) groups.

Conclusion

NLR and PLR serve as cost-effective biomarkers for identifying high-risk frequent exacerbators patients with COPD in primary care settings. The percentile-based scoring system enables management strategies to address clinical needs in resource-constrained healthcare environments.

Advanced Assessment of Oxidative Stress and Inflammation in Military Personnel: Development of a Novel IIRPM Score Using Artificial Intelligence

Background/Objectives: The health of military personnel in modern operational settings is critical for sustaining defense readiness. Extended exposure to extreme conditions can cause oxidative stress and systemic inflammation, potentially affecting performance. To address this problem, we developed an innovative diagnostic tool, the Post-Mission Integrated Risk Index (IIRPM), which integrates hematologic markers with key clinical variables. A novel aspect of the approach is the incorporation of ΔNLR, thus quantifying the change in the neutrophil-to-lymphocyte ratio measured before and after deployment, thereby providing a sensitive indicator of the inflammatory impact of operational stress. Methods: In this retrospective study, we analyzed comprehensive clinical and biological data from 443 military personnel over a ten-year period, with measurements taken before and after missions. We applied robust statistical techniques, including paired t-tests and Pearson correlation analyses, to assess variations in hematologic and metabolic parameters. Data segmentation was performed using Gaussian mixture models, and the predictive performance of the resulting model was validated with a multi-layer perceptron (MLP) neural network. Results: The analysis revealed significant post-mission increases in both the baseline NLR and ΔNLR, accompanied by notable shifts in metabolic markers. Data segmentation identified three distinct profiles: a reference profile characterized by stable immunologic parameters, an acute inflammatory response profile, and a proinflammatory metabolic profile marked by elevated cholesterol levels and higher mean age. Remarkably, the MLP model achieved 100% accuracy on the test set, with an average cross-validation accuracy of 97%. Conclusions: The IIRPM-which incorporates ΔNLR, age, mission duration, and cholesterol levels-offers a novel strategy to assess inflammatory risk among military personnel, thus facilitating personalized preventive interventions. Further validation in multicenter and longitudinal studies is anticipated to consolidate the clinical utility of this tool, ultimately fostering a more adaptive approach in military medicine to address the complex challenges of modern operational theaters.

Predictive Value of the Neutrophil-to-Lymphocyte Ratio/Serum Albumin for All-Cause Mortality in Critically Ill Patients Suffering from COPD

Background

Among critically ill patients, chronic obstructive pulmonary disease (COPD) is an independent risk factor for death. Recently, biomarkers such as neutrophil-lymphocyte ratio (NLR) and albumin (ALB) have been used to predict the prognosis in patients with COPD. However, the association between NLR/ALB and all-cause mortality in critically ill COPD patients remains unclear. This study aims to explore the association between the NLR/ALB and prognosis in critically ill patients with COPD.

Methods

Data was sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Primary outcome was 28-day all-cause mortality, with secondary outcomes being in-hospital and 90-day all-cause mortality. The area under the receiver operating characteristic curve (AUROC) was calculated to compare prognostic accuracy of NLR, NLR/ALB, PLR, SII and MLR variables. After identifying the most predictive factor, KM survival curves, Cox models and subgroup analyses were used to examine NLR/ALB's relationship with mortality in critically ill COPD patients. Additionally, patients with COPD from the National Health and Nutrition Examination Survey data (1999-2018) was used with Cox regression to investigate NLR/ALB's correlation with all-cause mortality in COPD patients.

Results

1916 critically ill COPD patients from MIMIC IV, divided into quartiles by NLR/ALB levels: Q1 (NLR/ALB<1.108), Q2 (2.095>NLR/ALB≥1.108), Q3 (4.221>NLR/ALB≥2.095), Q4 (NLR/ALB≥4.221). In multivariate Cox regression, Q4 vs Q1: 28-day mortality HR=2.27 (95% CI: 1.63-3.16); 90-day mortality HR=2.06 (95% CI: 1.56-2.71); in-hospital mortality HR=1.93 (95% CI: 1.35-2.77); P<0.001. Subgroup analyses showed that the correlation between NLR/ALB and 28-day mortality was stable Additionally, we recruited 2,003 COPD patients from the NHANES that found NLR/ALB also correlated with all-cause mortality in COPD (In multivariate Cox regression: Q4 vs Q1 hR=1.92 (95% CI: 1.45-2.55, P<0.001)).

Conclusion

Elevated NLR/ALB levels are associated with increased all-cause mortality in critically ill patients with COPD.

Red cell distribution width related to the severity of the disease in patients with AECOPD

AIMS

This research aims to elucidate the association between red cell distribution width (RDW) and the severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

PATIENTS & METHODS

This retrospective study enrolled patients with AECOPD and healthy controls. A comprehensive meta-analysis was further conducted by systematically searching PubMed, Embase, and the Cochrane Library up to 27 April 2023.

RESULTS

Univariate logistic regression analysis indicated that elevated RDW levels were significantly associated with AECOPD (p = 0.016). The pooled results yielded a diagnostic sensitivity of 0.76 (95% CI: 0.70-0.81) and specificity of 0.53 (95% CI: 0.38-0.68) for RDW in predicting AECOPD severity.

CONCLUSION

Elevated RDW levels exhibit a linear positive correlation with AECOPD severity, further supported by meta-analysis.

Association between dust exposure and lung function levels in steelworkers: mediation analysis of inflammatory biomarkers

PURPOSE

This investigation aimed to examine the mediating effect of inflammatory biomarkers on the relationship between dust exposure and lung function levels among steelworkers.

METHODS

The study comprised 2,315 front-line workers employed at an iron and steel company in Tangshan, who underwent occupational health assessments through cluster sampling. Demographic and lifestyle data were collected via a self-administered questionnaire, while physical examinations measured parameters such as height and weight. Lung function was assessed using a portable pulmonary function tester (CHEST). Blood cell counts were uniformly analyzed using a Mindray fully automated biochemistry analyzer (BS-800). Inflammatory biomarkers, including leukocyte count, neutrophil count, lymphocyte count, and platelet count, were assessed, and the neutrophil-to-lymphocyte ratio and systemic immune inflammation index were computed. Generalized linear models and Spearman rank correlation analyses were employed to explore the interplay among dust exposure, inflammatory biomarkers, and alterations in lung function. A mediation analysis model was constructed to elucidate how inflammatory biomarkers mediate the relationship between dust exposure and lung function levels.

RESULTS

After adjusting for covariates, dust exposure was significantly associated with reduced lung function levels, with statistically significant differences observed between dust-exposed and non-exposed groups across various lung function indicators (P < 0.001). In the dust-exposed group, inflammatory biomarkers were elevated, showing significant correlations with FVC and FEV1 (P < 0.05). However, the correlation between FEV1/FVC and various inflammatory biomarkers was insignificant (P > 0.05). Mediation analysis revealed that white blood cells and neutrophils partially mediated the association between dust exposure and FVC, with proportions of 1.75% and 1.09%, respectively. Similarly, white blood cells, neutrophils, and the systemic immune inflammation index partially mediated the association between dust exposure and FEV1, with proportions of 1.15%, 0.82%, and 0.82%, respectively.

CONCLUSION

In conclusion, dust exposure poses a risk for decreased lung function levels. Inflammatory biomarkers derived from blood cells offer a valuable and easily obtainable means of identifying changes in lungfunction levels. Among these biomarkers, white blood cells, neutrophils, and the systemic immune inflammation index significantly mediate the association between dust exposure and lung function levels, although further exploration is needed to understand their underlying mechanisms.

Abnormal expression of serum miR-4746-5p in liver cancer patients after interventional chemotherapy and its possible mechanism

Interventional chemotherapy is a common operation in the clinical treatment of liver cancer. The aim of this study was to investigate the expression and molecular mechanism of serum miR-4746-5p in liver cancer patients before and after interventional chemotherapy. The levels of miR-4746-5p and CDKN1C in serum samples from liver cancer patients were detected using real-time fluorescence quantitative polymerase chain reaction. Receiver operating characteristic curves revealed the diagnostic value of miR-4746-5p in tumors. Differences in clinical indicators between liver cancer patients and healthy controls were assessed using Pearson correlation analysis. Luciferase reporter gene assays confirmed the targeted interaction between miR-4746-5p and CDKN1C. In vitro cellular assays were validated by Cell Counting Kit-8, Transwell assay, and chemoresistance assay. Serum miR-4746-5p levels were increased in liver cancer patients but were downregulated after chemotherapy intervention. CDKN1C expression showed the opposite trend. Low levels of miR-4746-5p mediated cell growth and metastasis by targeting and negatively regulating CDKN1C expression, while silencing CDKN1C restored cell activity. Inhibition of miR-4746-5p reduced chemoresistance, while downregulation of CDKN1C affected cell sensitivity. miR-4746-5p may be a potential therapeutic factor for liver cancer diagnosis and interventional chemotherapy.

The Biomarker Potential of the Neutrophil-to-Lymphocyte Ratio in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background Chronic obstructive pulmonary disease (COPD) is characterized by periods of exacerbations and seasonal variations due to the recruitment of inflammatory cells. Various cells, such as neutrophils, lymphocytes, and the inflammatory mediators released by them, play a role in its pathogenesis. The current study was conducted to determine the role of the neutrophil-to-lymphocyte ratio (NLR) as a marker in acute exacerbation of COPD (AECOPD). Materials and methods We conducted a cross-sectional observational study at a tertiary care center in Western Maharashtra over six months after receiving approval from the institutional ethics committee. The study included 50 patients with AECOPD and 30 age and gender-matched controls without COPD. The patients were examined with a detailed history, complete blood count, and spirometry. The NLR was calculated and patients' disease severity was assessed using Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging. Results The mean age in the AECOPD group was 67.5 ± 12.5 years, whereas it was 46.2 ± 18.5 years in the control group. There was a male predominance in the AECOPD group (32/50). The majority of patients were in the GOLD stage 2 (42/50), followed by GOLD stage 3 (7/50). A total of 28 out of 50 AECOPD patients required admission to the medical intensive care unit. In the AECOPD group, 39 were smokers, and 11 were nonsmokers. Smoking was significantly associated with AECOPD when compared with controls. The mean NLR was 10.9 ± 10.2 in AECOPD patients and 4.3 ± 3.1 in the controls. Among cases with high NLR (≥5), seven required mechanical ventilation, 13 required noninvasive ventilation (NIV), and six succumbed to death. The mean duration of mechanical ventilation in this group was 12.5 ± 4.5 days, and for NIV, it was 7.5 ± 5.5 days. Conversely, patients with lower NLR (≤5) were more likely to avoid artificial ventilation and had a better in-hospital outcome. Conclusion COPD exacerbations can harm a patient's health, lead to disease progression, and increase mortality rates. Predicting exacerbations in advance can aid in early detection and treatment. NLR is an inexpensive, noninvasive, and easily available marker of inflammation and a predictor of outcome in AECOPD patients and hence should be calculated routinely in all patients with COPD.

New markers in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD), a global healthcare and socioeconomic burden, is a multifaceted respiratory disorder that results in substantial decline in health status and life quality. Acute exacerbations of the disease contribute significantly to increased morbidity and mortality. Consequently, the identification of reliable and effective biomarkers for rapid diagnosis, prediction, and prognosis of exacerbations is imperative. In addition, biomarkers play a crucial role in monitoring responses to therapeutic interventions and exploring innovative treatment strategies. Although established markers such as CRP, fibrinogen and neutrophil count are routinely used, a universal marker is lacking. Fortunately, an increasing number of studies based on next generation analytics have explored potential biomarkers in COPD. Here we review those advances and the need for standardized validation studies in the appropriate clinical setting.

Platelet count and platelet-to-lymphocyte ratio at the onset of a severe COPD exacerbation are unrelated to the time till the next moderate or severe relapse

PURPOSE

Acute exacerbations (AE) are severe complications of chronic obstructive pulmonary disease (COPD); however, the need for biomarkers which predict them is still unmet. High platelet count (PLC) and platelet-to-lymphocyte ratio (PLR) are associated with higher mortality in patients with COPD. We investigated if PLC and PLR at the onset of a severe AE could predict the time of the next relapse.

METHODS

In a prospective observational cohort study, data of 152 patients hospitalized with AECOPD were collected, and patients were divided into PLC-low (<239 ​× ​109/L, n ​= ​51), PLC-medium (239-297 ​× ​109/L, n ​= ​51) and PLC-high (>297 ​× ​109/L, n ​= ​50) or PLR-low (<147, N ​= ​51), PLR-medium (147-295, n ​= ​51) and PLR high (>295, n ​= ​50) groups based on PLC and PLR tertiles using admission laboratory results. Clinical characteristics and the time to the next severe or moderate AE within 52 weeks were compared among subgroups using log-rank test.

RESULTS

PLC and PLR tertiles did not differ in clinical characteristics or the time till the next AE (p ​> ​0.05). PLC and PLR showed a direct weak correlation to neutrophil count (Pearson r ​= ​0.26, p ​< ​0.01 and r ​= ​0.20, p ​= ​0.01) and PLC also demonstrated a weak relationship to white blood cell counts (Pearson r ​= ​0.29, p ​< ​0.001). However, PLR presented an inverse relationship to monocyte and eosinophil counts (r ​= ​-0.32, p ​< ​0.001 and r ​= ​-0.17, p ​= ​0.03).

CONCLUSION

PLC and PLR do not predict the time till the next relapse; however, they may reflect on neutrophilic inflammatory response during an exacerbation of COPD.

Relationship Between Systemic Immune-Inflammation Index and Risk of Respiratory Failure and Death in COPD: A Retrospective Cohort Study Based on the MIMIC-IV Database

Purpose

Chronic obstructive pulmonary disease (COPD) concurrent with respiratory failure (RF) is devastating, and may result in death and disability. Systemic immune-inflammation index (SII) is a new prognostic biomarker linked to unfavorable outcomes of acute coronary syndrome, ischemic stroke, and heart failure. Nonetheless, its role in COPD is rarely investigated. Consequently, this study intends to assess the accuracy of SII in predicting the prognosis of COPD.

Patients and Methods

The clinical information was retrospectively acquired from the Medical Information Mart for Intensive Care-IV database. The outcomes encompassed the incidence of RF and mortality. The relationship between different SII and outcomes was examined utilizing the Cox proportional-hazards model and restricted cubic splines. Kaplan-Meier analysis was employed for all-cause mortality.

Results

The present study incorporated 1653 patients. During hospitalization, 697 patients (42.2%) developed RF, and 169 patients (10.2%) died. And 637 patients (38.5%) died during long-term follow-up. Higher SII increased the risk of RF (RF: HR: 1.19, 95% CI 1.12-1.28, P<0.001), in-hospital mortality (HR: 1.22, 95% CI 1.07-1.39, P=0.003), and long-term follow-up mortality (HR: 1.12, 95% CI 1.05-1.19, P<0.001). Kaplan-Meier analysis suggested a significantly elevated risk of all-cause death (log-rank P<0.001) in patients with higher SII, especially during the short-term follow-up period of 21 days.

Conclusion

SII is closely linked to an elevated risk of RF and death in COPD patients. It appears to be a potential predictor of the prognosis of COPD patients, which is helpful for the risk stratification of this population. However, more prospective studies are warranted to consolidate our conclusion.

Single-cell immunophenotyping revealed the association of CD4+ central and CD4+ effector memory T cells linking exacerbating chronic obstructive pulmonary disease and NSCLC

Introduction

Tobacco smoking generates airway inflammation in chronic obstructive pulmonary disease (COPD), and its involvement in the development of lung cancer is still among the leading causes of early death. Therefore, we aimed to have a better understanding of the disbalance in immunoregulation in chronic inflammatory conditions in smoker subjects with stable COPD (stCOPD), exacerbating COPD (exCOPD), or non-small cell lung cancer (NSCLC).

Methods

Smoker controls without chronic illness were recruited as controls. Through extensive mapping of single cells, surface receptor quantification was achieved by single-cell mass cytometry (CyTOF) with 29 antibodies. The CyTOF characterized 14 main immune subsets such as CD4+, CD8+, CD4+/CD8+, CD4-/CD8-, and γ/δ T cells and other subsets such as CD4+ or CD8+ NKT cells, NK cells, B cells, plasmablasts, monocytes, CD11cdim, mDCs, and pDCs. The CD4+ central memory (CM) T cells (CD4+/CD45RA-/CD45RO+/CD197+) and CD4+ effector memory (EM) T cells (CD4+/CD45RA-/CD45RO+/CD197-) were FACS-sorted for RNA-Seq analysis. Plasma samples were assayed by Luminex MAGPIX® for the quantitative measurement of 17 soluble immuno-oncology mediators (BTLA, CD28, CD80, CD27, CD40, CD86, CTLA-4, GITR, GITRL, HVEM, ICOS, LAG-3, PD-1, PD-L1, PD-L2, TIM-3, TLR-2) in the four studied groups.

Results

Our focus was on T-cell-dependent differences in COPD and NSCLC, where peripheral CD4+ central memory and CD4+ effector memory cells showed a significant reduction in exCOPD and CD4+ CM showed elevation in NSCLC. The transcriptome analysis delineated a perfect correlation of differentially expressed genes between exacerbating COPD and NSCLC-derived peripheral CD4+ CM or CD4+ EM cells. The measurement of 17 immuno-oncology soluble mediators revealed a disease-associated phenotype in the peripheral blood of stCOPD, exCOPD, and NSCLC patients.

Discussion

The applied single-cell mass cytometry, the whole transcriptome profiling of peripheral CD4+ memory cells, and the quantification of 17 plasma mediators provided complex data that may contribute to the understanding of the disbalance in immune homeostasis generated or sustained by tobacco smoking in COPD and NSCLC.

Association of Red Cell Index and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Purpose

This study aims to explore the association between red cell index (RCI) and hospital mortality in Chronic Obstructive Pulmonary Disease (COPD) patients in the intensive care unit.

Patients and Methods

This was a retrospective cohort research. The study included 821 COPD patients. Clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database was conducted. Multivariate logistic regression analysis was used to assess the correlation between RCI and in-hospital mortality. Age, SOFA score, diabetes mellitus, cerebrovascular disease, congestive heart failure and mechanical ventilation were considered for subgroup analysis.

Results

This study comprised 821 patients, of which 16.5% (124/821) suffered hospital mortality. In the multivariate logistic regression model, RCI was positively associated with hospital mortality, each unit increase in RCI was associated with a 3% increase in hospital mortality (odds ratio [OR] =1.03; 95% confidence interval [95CI%] =1.01-1.06). Meanwhile, compare with the lowest RCI group, the highest RCI groups tended to have higher risks of hospital mortality (OR [95% CI] 2.33 [1.27-4.27]). Additionally, subgroup analysis result was persistent among all the groups.

Conclusion

Higher RCI was positively associated with a higher risk of mortality in critically ill patients with COPD. Further investigation is necessary to confirm these findings.

The clinical relevance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic obstructive pulmonary disease with lung cancer

Background

Chronic obstructive pulmonary disease (COPD) coexisting with lung cancer is associated with severe mortality and a worse prognosis. Inflammation plays an important role in common pathogenic pathways and disease progression. However, a few studies have identified the clinical value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in COPD with lung cancer, which are systemic inflammatory response markers in the blood. This study aimed to determine the association of the NLR or PLR with clinical characteristics and whether NLR or PLR can be diagnostic markers for COPD with lung cancer.

Methods

Between 2015 and 2021, we conducted a retrospective analysis of 236 COPD patients with lung cancer and 500 patients without lung cancer (control group). Clinical information, blood routine examination, and spirometry results were collected and analyzed. The receiver operating characteristic (ROC) curve was used to identify the best cutoff point of NLR or PLR. Multivariate logistic regression analysis was performed to evaluate the association of NLR or PLR with the diagnosis and prognosis of COPD with lung cancer.

Results

Compared to patients in the COPD-only group, patients in the lung cancer group had a higher percentage of current smoking and emphysema, and it was found that NLR or PLR was significantly higher in the lung cancer group. Multivariate analysis showed that age, smoking status, FEV1%pred, emphysema, NLR, and PLR were independent risk factors for lung cancer development in COPD. Furthermore, the high level of NLR or PLR was associated with age over 70 years old, current smoking status, and ineligible surgery treatment. The level of PLR or NLR markedly increased with hypercoagulation status, the severity of airflow limitation, and advanced progression of lung cancer. Additionally, the ROC analysis also revealed that elevated NLR or PLR was an independent predictor of COPD in lung cancer patients, TNM stages IIIB–IV at first diagnosis in lung cancer, and ineligible surgery in lung cancer patients.

Conclusion

Increased NLR or PLR values might be an important and easily measurable inflammation biomarker to predict the diagnosis and severity of lung cancer with COPD.

The Emerging Clinical Significance of the Red Cell Distribution Width as a Biomarker in Chronic Obstructive Pulmonary Disease: A Systematic Review

There is an intense focus on the identification of novel biomarkers of chronic obstructive pulmonary disease (COPD) to enhance clinical decisions in patients with stable disease and acute exacerbations (AECOPD). Though several local (airway) and circulatory inflammatory biomarkers have been proposed, emerging evidence also suggests a potential role for routine haematological parameters, e.g., the red cell distribution width (RDW). We conducted a systematic literature search in PubMed, Web of Science, and Scopus, from inception to April 2022, for articles investigating the diagnostic and prognostic role of the RDW in stable COPD and AECOPD. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Significant associations between the RDW and the presence and severity of disease, outcomes (mortality, hospital readmission), and other relevant clinical parameters (right heart failure, pulmonary arterial hypertension) were reported in 13 out of 16 studies in stable COPD (low risk of bias in 11 studies), and 17 out of 21 studies of AECOPD (low risk of bias in 11 studies). Pending further research, our systematic review suggests that the RDW might be useful, singly or in combination with other parameters, for the diagnosis and risk stratification of patients with stable COPD and AECOPD (PROSPERO registration number: CRD42022348304).

Association of Red Cell Index and Adverse Hospitalization Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: A Retrospective Cohort Study

Purpose

Previous studies have shown that the red cell index (RCI) can be considered as a simple and useful method to evaluate respiratory function. However, at present its association with adverse hospitalization outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not fully understood. Our study aimed to examine the relationship between adverse hospitalization outcomes and RCI among AECOPD patients.

Patients and Methods

We performed a retrospective analysis of consecutive patients from January 2015 to October 2021. In this study, RCI was the independent variable, measured at baseline, and adverse hospitalization outcome was the dependent variable. According to the RCI median (RCI=2.221), we divided 377 patients into two roughly equal groups (188 and 189, respectively). Next, the association between RCI and adverse hospitalization outcomes was explored using multivariable logistic regression models. To identify any non-linear relationship, a generalized additive model (GAM) was employed.

Results

With a total of 377 patients with AECOPD, we divided them into two roughly equal groups to compare the clinical factors and RCI levels. The patients in the higher RCI group showed poorer outcome incidence (18 [9.57%] vs 31 [16.40%]; p = 0.049). After accounting for potential confounders, the results showed that RCI was positively associated with adverse hospitalization outcomes (odds ratio [OR] = 1.15, 95% CI: 1.01-1.32). In addition, a non-linear relationship was detected between RCI and adverse hospitalization outcomes, which had an inflection point of 3.2. There were odds ratios and confidence intervals of 0.8 (0.7-1.0) and 1.3 (1.2-1.4) on the left and right sides of the inflection point, respectively.

Conclusion

The RCI and adverse hospitalization outcomes exhibited a non-linear relationship in the AECOPD patients. RCI is strongly positively correlated with adverse hospitalization outcomes when it was greater than 3.2.

Circulating Complement C1q as a Novel Biomarker is Associated with the Occurrence and Development of COPD

Purpose

Increasing evidence has shown that the immune response interacts with the chronic inflammatory response and gives rise to the occurrence and development of COPD. Complement component 1q (C1q), as a subcomponent of the C1 complex, could be involved in innate and adaptive immunity. Our study aimed to investigate the relationship between C1q and the clinical characteristics of COPD subjects.

Patients and Methods

Serum C1q levels were measured in 203 COPD subjects and 191 non-COPD controls. Correlations between C1q and the characteristics of COPD were analyzed using Spearman’s rho. Receiver operating curve (ROC) analysis was used to evaluate the threshold value in differentiating disease status. All 203 COPD subjects were followed up for 1 year for future acute exacerbations.

Results

There were significant reductions in serum C1q levels in COPD subjects compared to non-COPD controls. Moreover, serum C1q levels were obviously positively correlated with the FEV1/FVC ratio and predicted FEV1% but had a weakly negative correlation with the %LAA-950 and the percentage of neutrophils in peripheral blood. Using a cutoff value of 137.150 mg/l as the boundary in ROC analysis, the sensitivity and specificity were 65.9% and 76.0%, respectively. The 1-year follow-up results showed that C1q levels less than 137.150 mg/l were negatively related to the time to the next severe exacerbation and the time to death.

Conclusion

Circulating C1q levels may be a novel biomarker not only related to the pulmonary function of COPD but also having great potential to predict the risk of COPD deterioration in the future. However, further prospective trials are needed to clarify the influences of C1q on the pathogenesis of COPD.

What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?

Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis.

Association of baseline parameters with year 0 and year 1 acute exacerbations in male patients with chronic obstructive pulmonary disease

Objectives

Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) can affect health status, hospitalization and readmission rates, and disease progression. This study aimed to identify independent markers associated with COPD AEs.

Methods

This study included male patients with COPD and collected data regarding their AEs and baseline clinical parameters.

Results

We included 149 male patients. Among them, 58 were included in the year 0 high-AE group and 91 in the low-AE group. Multivariate analysis revealed that the high-AE group had higher white blood cell count, lower serum albumin level, and post-bronchodilator (BD) forced expiratory volume in one second (FEV₁) (%) with a combined receiver operating characteristic curve (ROC) of 0.721 (p < 0.001). Additionally, 34 patients were included in the year 1 high-AE group and 70 in the low-AE group (p < 0.001). Multivariate analysis revealed that the high-AE group had higher platelet count, positive asthma history, and lower pre-BD FEV₁ (%) with a combined ROC of 0.782 (p < 0.001).

Conclusion

In male patients with COPD, baseline white blood cell count, albumin level, and post-BD FEV₁ (%) were correlated with year 0 AE; on the other hand, baseline platelet count, positive asthma history, and pre-BD FEV₁ (%) were associated with year 1 AE.

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.

Cellular Indices and Outcome in Patients with Acute Venous Thromboembolism

Background

Cellular indices provide integrative information about systemic inflammation status which is readily available from routine laboratory parameters. This study aimed to evaluate the prognostic role of three cellular indices in patients with venous thromboembolism (VTE).

Methods

The RIETE registry database was used to determine the association between the baseline neutrophil-to-lymphocyte-ratio (NLR), platelet-to-lymphocyte-ratio (PLR) and systemic-immune-inflammation-index (SII) for 90-day adverse outcomes in patients with acute VTE.

Results

From January 2020 to April 2021, 4487 patients with acute VTE were recruited in the RIETE registry. Of these, 2683 presented with symptomatic pulmonary embolism (PE); 283 with incidental PE; 1129 with lower-limb deep vein thrombosis (DVT); 175 with upper-limb DVT; 69 with splanchnic vein thrombosis; 142 with superficial vein thrombosis and 20 with retinal vein thrombosis. Mean values were: NLR 5.9 ± 7.1, PLR 190 ± 158 and SII 1459 ± 2028. During the first 90-days, 38 patients (0.8%) developed recurrent DVT, 45 (1.0%) had recurrent PE, 152 (3.4%) suffered major bleeding, and 484 (11%) died. On multivariable analysis, patients with NLR >4.41 were at an increased risk for major bleeding and patients with NLR >4.96 were at the risk of death, while those with SII >1134.5 were at increased risk for death.

Conclusions

This study reports the results of a large cohort to date which evaluate the prognostic value of three cellular indices simultaneously in patients with acute VTE. Results support that none of the three baseline cellular indices were sufficient for prediction of VTE recurrences in acute VTE patients. The patients with higher baseline NLR values were at an increased risk of major bleeding or death, those with high SII values were only at an increased risk for mortality.

A retrospective correlative profiling of lung functions, microbiological, radiological, periodontal, hematological parameters in noncystic fibrosis bronchiectasis patients of North India

Introduction:

Noncystic fibrosis bronchiectasis (NCFB) is a neglected debilitating condition with scarce epidemiological literature explaining its geographical heterogeneity, especially in lower and middle-income countries. This study aimed to assess and correlate the functional profile of NCFB patients and evaluate the correlation of body mass index (BMI) with several disease variables.

Methods:

This mixed-method retrospective research study was conducted on 124 radiologically confirmed NCFB patients in terms of various qualitative and quantitative variables.

Results:

Restrictive ventilatory defect was the most common type with the preponderance of male former smokers. Mean platelet lymphocyte ratio (PLR; 104.08 ± 73.59) revealed certain degree of systemic inflammatory burden with a slightly higher mean peripheral leukocyte count (10665.19 ± 4268.81 cell/mm³) and eosinophilia of >2%. Almost all patients had periodontal disease with a higher prevalence of chronic periodontitis (54.83%). Moderately severe and predominantly cystic radiological type was encountered with 61.2% patients positive for Pseudomonas aeruginosa. Bronchiectasis aetiology comorbidity index (BACI) i.e., 2.34 ± 2.37 represented an intermediate mortality risk in our patients. On basis of BMI, majority were young underweights with poor pulmonary functions while PLR skewed toward overweight patients (nonsignificant P > 0.05). Forced expiratory volume/forced vital capacity displayed a negative weak moderately significant correlation with BACI (r = −0.24; P = 0.008). Peripheral lymphocyte count demonstrated a weak negative but significant correlation with modified Reiff score (r = −0.20; P = 0.023) while serum neutrophil count had a weak negative moderately significant correlation with hemoglobin (r = −0.20; P = 0.023).

Conclusions:

NCFB bears great heterogeneity with distinct geographical phenotypes and should be correlated thoroughly in terms of peripheral leukocytes count, pulmonary functions, radiology, BMI, and coexisting comorbidities for adequate management.

ΔRDW: A Novel Indicator with Predictive Value for the Diagnosis and Treatment of Multiple Diseases

Elevated red blood cell distribution width (RDW) is a powerful predictor of poor prognosis in a variety of diseases, but a single measurement of RDW cannot reflect the dynamic change of diseases. ΔRDW, as a risk stratification tool, can be used to record changes in RDW before and after treatment; also, it allows investigators to name the unit change of RDW in the studied population. So far, there have been few relevant studies on the predictive value of ΔRDW for different diseases; this article aims to review the studies and summaries of the current understandings on the correlation between ΔRDW and disease outcomes.

Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?

BACKGROUND

Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD).

AIM/OBJECTIVE

The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)).

METHODS

Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated.

RESULTS

2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined.

CONCLUSION

Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

Characteristics of length of stay and cardiovascular pharmacotherapy advice among chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) increases the global disease burden due to its diverse adverse health effects on the respiratory and cardiovascular systems. This study aimed to elucidate the potential indicators of length of stay (LOS) and pharmacotherapy advice among COPD patients. Thereafter, hospitalized COPD patients with clinical records and respiratory and cardiovascular pharmacotherapy advice were retrospectively collected from a tertiary hospital between April 2017 and September 2020, and the determinants of LOS and cardiovascular pharmacotherapy advice were explored using regression analyses. Overall, 475 patients with COPD were recruited and stratified according to exacerbation and presence of Cor pulmonale (CP). The extended LOS, increased B-type natriuretic peptides (BNP), and a higher percentage of cardiovascular pharmacotherapy advice were observed in COPD with CP regardless of exacerbation, although the percentage of respiratory prescriptions was comparable. The presence of CP indicated a longer LOS (B = 1.850, p < 0.001) for COPD regardless of exacerbation. Meanwhile, elevated BNP levels indicated cardiovascular pharmacotherapy advise for both COPD in exacerbation (OR = 1.003, p = 0.012) and absence of exacerbation (OR = 1.006, p = 0.015). Moreover, advice for trimetazidine use for COPD in exacerbation (OR = 1.005, p = 0.002) has been suggested. Therefore, CP appears to be an important comorbidity resulting in extended LOS for COPD, which is likely to be advised with cardiovascular pharmacotherapy, which might be guided through BNP monitoring.

Pulmonary embolism with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.

Red cell distribution width: A new parameter for predicting the risk of exacerbation in COPD patients

BACKGROUND

Red cell distribution width (RDW) is a numerical measurement of the size variability of erythrocytes and is routinely reported as a component of complete blood count in the differential diagnosis of anemia. In recent years, researchers have reported high mortality and poor prognosis associated with higher RDW in populations with cardiovascular disease, cancer, pneumonia, and chronic obstructive pulmonary disease (COPD). The aim of the study is to evaluate the role of RDW in predicting the risk of COPD exacerbations and the impact of symptoms.

METHODS

We designed an observational retrospective study based on patients hospitalized for acute exacerbation of COPD, between January 2015 and December 2018.

RESULTS

We included 169 patients, 120 at GOLD four stage. RDW was significantly higher in COPD patients vs controls (P = .014). We found a positive correlation with c-reactive protein (r  = 0.375, P < .01), COPD assessment test (CAT) Score (R2 = 0.658, sy.x = 2.226; P < .01), number of exacerbations (R2=0.289; sy.x = 0.86; P = .002), and GOLD score (r = 0.30; P = .05). In ROC curve analysis, the area under the curve of RDW for the identification of frequent exacerbator was 1.0 (95% confidence interval, 1.0-1.0; P < .0001).

CONCLUSION

Our data show that elevated RDW may be a useful tool in predicting the risk of exacerbation in COPD patients and may be a good indicator of the impact of symptoms.

Emergency admission parameters for predicting in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease with hypercapnic respiratory failure

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation in emergency departments (ED) that can be fatal. This study aimed to develop a mortality risk assessment model for patients presenting to the ED with AECOPD and hypercapnic respiratory failure.

Methods

We analysed 601 participants who were presented to an ED of a tertiary hospital with AECOPD between 2018 and 2020. Patient demographics, vital signs, and altered mental status were assessed on admission; moreover, the initial laboratory findings and major comorbidities were assessed. We used least absolute shrinkage and selection operator (LASSO) regression to identify predictors for establishing a nomogram for in-hospital mortality. Predictive ability was assessed using the area under the receiver operating curve (AUC). A 500 bootstrap method was applied for internal validation; moreover, the model’s clinical utility was evaluated using decision curve analysis (DCA). Additionally, the nomogram was compared with other prognostic models, including CRB65, CURB65, BAP65, and NEWS.

Results

Among the 601 patients, 19 (3.16%) died during hospitalization. LASSO regression analysis identified 7 variables, including respiratory rate, PCO₂, lactic acid, blood urea nitrogen, haemoglobin, platelet distribution width, and platelet count. These 7 variables and the variable of concomitant pneumonia were used to establish a predictive model. The nomogram showed good calibration and discrimination for mortality (AUC 0.940; 95% CI 0.895–0.985), which was higher than that of previous models. The DCA showed that our nomogram had clinical utility.

Conclusions

Our nomogram, which is based on clinical variables that can be easily obtained at presentation, showed favourable predictive accuracy for mortality in patients with AECOPD with hypercapnic respiratory failure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-021-01624-1.

Platelet Count and Platelet Indices in Patients with Stable and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Platelets play an important role in the pathophysiology of chronic obstructive pulmonary disease (COPD) by mediating thrombotic, inflammatory, and immune processes in the lung. We conducted a systematic review and meta-analysis of studies investigating the platelet count and three platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), and platelet to lymphocyte ratio (PLR) in stable COPD vs. non-COPD patients and in stable COPD vs. acute exacerbation of COPD (AECOPD) patients (PROSPERO registration number: CRD42021228263). PubMed, Web of Science, Scopus and Google Scholar were searched from inception to December 2020. Twenty-seven studies were included in the meta-analysis, 26 comparing 4,455 stable COPD patients with 7,128 non-COPD controls and 14 comparing 1,251 stable COPD with 904 AECOPD patients. Stable COPD patients had significantly higher platelet counts (weighted mean difference, WMD = 13.39 x10⁹/L, 95% CI 4.68 to 22.11 x10⁹/L; p < 0.001) and PLR (WMD = 59.52, 95% CI 29.59 to 89.44; p < 0.001) than non-COPD subjects. AECOPD patients had significantly higher PLR values than stable COPD patients (WMD = 46.03, 95% CI 7.70 to 84.35; p = 0.02). No significant differences were observed in MPV and PDW. Between-study heterogeneity was extreme. In sensitivity analysis, the effect size was not modified when each study was sequentially removed. The was no evidence of publication bias. In our meta-analysis, specific platelet biomarkers were associated with stable COPD (platelet count and PLR) and AECOPD (PLR). However, the observed heterogeneity limits the generalizability of the findings. Further studies are required to determine their prognostic utility and the effects of targeted interventions in COPD.

Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: The hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio

Background

The objective of this study was to investigate the relationship among hypersensitive C-reactive protein to albumin ratio (CAR), fibrinogen to albumin ratio (FAR), and the CURB-65 score for community-acquired pneumonia (CAP) severity.

Methods

Clinical data and laboratory indicators of 82 patients with CAP and 40 healthy subjects were retrospectively analysed. The relationship among CAR, FAR, and the severity of CAP was then analysed.

Results

CAR and FAR in patients with low-risk CAP were significantly higher than those in the normal control group (P < 0.05). CAR and FAR in patients with medium-high-risk CAP were further increased compared with those in patients with low-risk CAP (P < 0.05). CAR and FAR were positively correlated with hypersensitive C-reactive protein, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and CURB-65 scores (P < 0.05). In the receiver operating characteristic curve for predicting severe CAP, the area under the curve of combining four biomarkers (CAR + FAR + NLR + PLR) was the largest. CAR was also an independent risk factor for severe CAP (OR = 8.789, 95% CI: 1.543-50.064, P = 0.014).

Conclusions

CAR and FAR may be used as the inflammatory markers for CAP severity evaluation.

Relationship of Red Cell Index with the Severity of Chronic Obstructive Pulmonary Disease

Background

We aimed to investigate the association between red cell index (RCI) and the severity of Chronic Obstructive Pulmonary Disease (COPD), and compare predictive value of RCI, neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) for the severity of COPD.

Methods

A total of 207 participants were recruited (100 COPD patients and 107 healthy controls). COPD patients were divided into two groups according to the optimal cut-off value of RCI determined by the receiver operating characteristic (ROC) curve. Pearson’s correlation test, logistic regression analysis and other tests were performed.

Results

Compared with low RCI group, the forced expiration volume in 1 second (FEV₁) and FEV₁ in percent of the predicted value (FEV₁%) in high RCI group were lower (p = 0.016, p = 0.001). There was a negative correlation between RCI and FEV₁% (r = −0.302, p = 0.004), while no correlation between FEV₁% and NLR as well as PLR were found. RCI showed higher predictive value than NLR and PLR for predicting Global Initiative for Chronic Obstructive Lung Disease classification (GOLD), with a cut-off value of 1.75 and area under the curve (AUC) of 0.729 (p = 0.001). Multivariate logistic regression analysis proved that RCI was an independent factor for lung function in COPD patients (odds ratio [OR] = 4.27, 95% CI: 1.57–11.63, p = 0.004).

Conclusion

RCI is a novel biomarker that can better assess pulmonary function and severity of COPD than NLR and PLR. Higher RCI is related to deterioration of pulmonary function.

Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR

Objectives: The major scores associated with the mortality after COPD exacerbations were; DECAF, CURB-65, PSI and BAP-65 scores. We aimed to compare these scores in predicting 30- and 90-day mortality in patients hospitalized with exacerbation of COPD.Methods: The data of 141 patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and accepted to participate in the study were prospectively recorded.Results: Age, mean modified-medical-research-council (mMRC) dyspnea score, pleural effusion, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), presence of atrial fibrillation (AF), PaCO2 pressure values were found to be significantly higher at both 30 and 90-days deceased group, while hemoglobin, albumin and pH values were significantly lower (all p < 0.05). DECAF, CURB-65, PSI and BAP-65 scores were significantly higher for both 30 and 90-days mortality (all p < 0.05). DECAF, CURB-65, PSI, BAP-65 scores, PLR, NLR predicted to 30 day and 90 day mortality. But, CURB-65 found (OR 2.968 and 2.284, respectively) superior to others in predicting 30 and 90-days mortality.Conclusions: CURB-65 score is a significant, simple and feasible score for predicting 30 and 90 days mortality in COPD exacerbation and may be routinely used in all patients hospitalized with COPD exacerbation.

The Relationship of Lymphocyte to High-Density Lipoprotein Ratio with Pulmonary Function in COPD

Purpose

This study aimed to explore the relation between lymphocyte to high-density lipoprotein ratio (LHR) and pulmonary function of chronic obstructive pulmonary disease (COPD) patients compared with neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR).

Patients and Methods

In total, 154 participants (n = 77 with COPD and n = 77 without COPD) were recruited. LHR, NLR, PLR, lung function and other data were collected and compared. Pearson’s correlation test and the receiver operating characteristics curves were used to compare the utility of LHR, NLR and PLR. Besides, univariate and multivariate logistic regression analyses were conducted.

Results

COPD patients with poorer lung function had a lower LHR level (P < 0.001). In low LHR group, more patients underwent greater airflow limitation than the other group (P = 0.006). LHR positively correlated with forced expiratory volume in 1 second in percent of the predicted value (FEV₁%) (r = 0.333, P = 0.003). At a cut-off value of 2.08, the sensitivity and specificity of LHR in predicting FEV₁% < 50 were 93.2% and 55.6%, respectively, with an AUC of 0.770 (P = 0.001) better than NLR and PLR. Based on logistic regression analyses, it was proved that LHR was associated with decreased risk of FEV₁ <50% predicted in COPD patients (odds ratio = 0.198, 95% CI: 0.048–0.811, P = 0.024).

Conclusion

In contrast with NLR and PLR, LHR has higher accuracy for predicting pulmonary function in COPD; lower LHR level is independently associated with poorer pulmonary function.

Serum biomarkers in patients with stable and exacerbated COPD-bronchiectasis overlap syndrome

INTRODUCTION

Bronchiectasis (B), commonly seen in patients with chronic obstructive pulmonary disease (COPD), is associated with exacerbations and predicts mortality.

OBJECTIVES

To differentiate patient groups with COPD-(B+) or COPD-(B-) and their exacerbations by using inflammatory markers.

METHODS

Consecutive COPD patients were divided into two groups according to findings on high resolution thorax CT (HRCT) images using Smith and modified Reiff scores. Patients were prospectively followed for possible future exacerbations. Serum fibrinogen, C-reactive protein (CRP), soluble urokinase-type plasminogen activator receptor (suPAR) and Plasminogen activator inhibitor-1 (PAI-1) levels were studied during exacerbation and stable periods.

RESULTS

Eighty-seven patients were included and (85 M, 2 F), mean aged was 68.1 ± 9 (46-87). HRCT confirmed bronchiectasis in 38 (43.7%) patients, most commonly in tubular form (89.4%) and in lower lobes. COPD-B(+) group had lower body mass index (P = 0.036), more advanced stage of disease (P = 0.004) and more frequent exacerbation (P = 0.01). The HRCT scores were correlated with exacerbation rate (r = 0.356, P < 0.05). Fibrinogen and CRP values were higher in exacerbation (P = 0.01, P = 0.013, respectively) especially in COPD-B(+) patients. suPAR and PAI-1 levels were also higher in COPD-B(+) patients although it was not statistically significant.

CONCLUSION

Bronchiectasis is common and causes frequent exacerbations in COPD. Identifying of COPD-B(+) phenotype by HRCT scoring systems has considerable importance for both therapeutic options and clinical outcome of the disease. In addition to fibrinogen and CRP, high serum levels of suPAR and PAI-1 suggest us their significant roles in increased systemic inflammation associated with coexisting of COPD and bronchiectasis.

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

BACKGROUND AND OBJECTIVE

Platelet activation, inflammatory reactions and oxidative stress are common pathogenesis of chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD). Mean platelet volume (MPV) and red blood cell distribution width (RDW) form part of the pathomechanisms of these conditions. Here, we investigated whether MPV and RDW can be biomarkers of PHD occurring secondary to COPD.

MATERIALS AND METHODS

This was a retrospective study on 229 participants with COPD. Among them, 69 had PHD. Complete blood count (CBC), blood gas analysis, pulmonary function tests and echocardiography were analyzed.

RESULTS

MPV and RDW-standard deviation (RDW-SD) were significantly higher in patients with PHD than in patients without PHD (P ≤ 0.001). MPV and RDW-SD were positively correlated with pulmonary artery pressure (PAP) and the size of the right ventricle (P ≤ 0.05). Multivariate regression analysis showed that the risk of PHD increased 3-fold per unit rise in MPV (OR = 2.901, P ≤ 0.001). We observed that the risk of PHD increased 1.5 times per unit rise in RDW-SD (OR = 1.371, P ≤ 0.001).The AUC of ROC curve for the combined MPV and RDW-SD in predicting PHD among COPD patients was 0.900 (95％CI: 0.846-0．954, P ≤ 0.001), with a sensitivity of 76.8% and a specificity of 99.4%.

CONCLUSIONS

Both MPV and RDW-SD were significantly elevated and correlated with disease severity in COPD patients with PHD. A combination of these two parameters presents an effective biomarker of PHD.

MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

BACKGROUND

The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1and 3month mortality.

METHODS

82 PE patients and 50 healthy control subjects were included in the study. Blood samples for Mr-proANP and Mr-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities.

RESULTS

The mean serum Mr-proANP and Mr-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with Mr-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with Mr-proADM ≥ 152.2 pg/mL showed a statistically significant increase.

CONCLUSIONS

This study showed that Mr-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

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.