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

Abstract

BackgroundThe ratio of neutrophils to lymphocytes (NLR) is a widely available marker of inflammation. Several types of inflammatory cells and mediators have been found to be involved in the progression of chronic obstructive pulmonary disease (COPD). We sought to evaluate the association of the NLR with severity of airflow limitation and disease exacerbations in a COPD population.MethodsWe analyzed 885 patients from the Korean COPD Subtype Study cohort that recruited subjects with COPD from 44 referral hospitals. We determined the relationship of NLR levels to severity of lung function using a linear regression model. In addition, we analyzed the experiences of COPD exacerbation according to the NLR quartiles.ResultsNLR levels were inversely associated with severity of airflow limitation as measured by FEV1% predicted and absolute values after adjustments for age, gender, body mass index, pack-years of smoking, and the use of inhaled corticosteroid (P<0.001, respectively). In the multivariate binary regression model, the NLR 4th quartile (vs. 1st quartile) was found to be a significant predictor of exacerbations during 1-year follow-up (OR = 2.05, 95% CI = 1.03 to 4.06, P = 0.041). Adding an NLR to FEV1 significantly improved prediction for exacerbations during 1-year follow-up as measured by the net reclassification improvement (NRI = 7.8%, P = 0.032) and the integrated discrimination improvement (IDI = 0.014, P = 0.021).ConclusionsThe NLR showed a significant inverse relationship to airflow limitation and was a prognostic marker for future exacerbations in patients with COPD.

Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

“…The authors evidenced that tricuspid atrial conduction time was significantly longer in COPD patients than in controls (26.4±11.4 ms versus 17.7±7.7 ms), and a significant positive correlation was identified between tricuspid atrial conduction time and NLR (r=0.38, p<0.001). These findings, as opposed to those of LEE et al [38], which suggest that specific comorbidities can influence the kinetics of NLR.…”

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as haematological indices of inflammatory response in ceramic workers’ silicosis

“…NLR has been shown to be an independent prognostic factor in several types of tumours, including colorectal, lung, breast, pancreatic, gastric and ovarian cancer . Studies have also shown a correlation between the NLR and the prognosis and severity of the clinical course in pulmonary diseases such as chronic obstructive pulmonary disease, acute respiratory distress syndrome, community‐acquired pneumonia and sarcoidosis and tuberculosis . In this study, NLR has been found to be statistically significantly higher in silicosis patients with profusion categories 2 and 3 when compared to the control group.…”

Clinical characteristics of chronic bronchitic, emphysematous and ACOS phenotypes in COPD patients with frequent exacerbations

“…Previous studies suggested that NLR (examining together the influences of neutrophilia and lymphopenia) reflected systemic inflammatory status in COPD, which was one of the independent predictors of future exacerbations 24,25. However, we found that NLR did not associate with FE in COPD in our study.…”