Peripheral Neutrophil-to-Lymphocyte Ratio in Bronchiectasis: A Marker of Disease Severity

Abstract

Most patients with bronchiectasis have a predominantly neutrophilic inflammatory profile, although other cells such as lymphocytes (as controllers of bronchial inflammation) and eosinophils also play a significant pathophysiological role. Easy-to-interpret blood biomarkers with a discriminative capacity for severity or prognosis are needed. The objective of this study was to assess whether the peripheral neutrophil-to-lymphocyte ratio (NLR) is associated with different outcomes of severity in bronchiectasis. A total of 1369 patients with bronchiectasis from the Spanish Registry of Bronchiectasis were included. To compare groups, the sample was divided into increasing quartiles of NLR ratio. Correlations between quantitative variables were established using Pearson’s P test. A simple linear regression (with the value of exacerbations as a quantitative variable) was used to determine the independent relationship between the number and severity of exacerbations and the NLR ratio. The area under the curve (AUC)-ROC was used to determine the predictive capacity of the NLR for severe bronchiectasis, according to the different multidimensional scores. Mean age: 69 (15) years (66.3% of women). The mean NLR was 2.92 (2.03). A higher NLR was associated with more severe bronchiectasis (with an especially significant discriminative power for severe forms) according to the commonly used scores (FACED, E-FACED and BSI), as well as with poorer quality of life (SGRQ), more comorbidities (Charlson index), infection by pathogenic microorganisms, and greater application of treatment. Furthermore, the NLR correlated better with severity scores than other parameters of systemic inflammation. Finally, it was an independent predictor of the incident number and severity of exacerbations. In conclusion, the NLR is an inexpensive and easy-to-measure marker of systemic inflammation for determining severity and predicting exacerbations (especially the most severe) in patients with bronchiectasis.

Predictive Value of the Advanced Lung Cancer Inflammation Index for the Postoperative Complications of Lung Resections in Patients with Bronchiectasis: A Retrospective Study Short Title : Study on the Correlation between the Advanced Lung Cancer Inflammation Index and Patients with Bronchiectasis

“…There is growing evidence that in ammatory and nutritional biomarkers in peripheral blood can predict the progression and overall prognosis of bronchiectasis patients. A high NLR is indicative of worsening conditions in these patients [27]. A study from a nationwide population in South Korea highlighted that being underweight (BMI < 18.5 kg/m 2 ) is a risk factor for bronchiectasis in young individuals [28].…”

“…The NLR represents the severity of the innate immune response, i.e., the severity of in ammation caused mainly by bacterial infection. Patients with bronchiectasis have reduced levels of lymphocytes, and lower lymphocyte counts may be associated with an unlimited innate immune response [24,27,36,37]. Therefore, the ALI has emerged as a comprehensive indicator, encapsulating the anthropometric, nutritional, and in ammatory factors crucial for assessing patients with bronchial dilation.…”

Systemic immune-inflammation index in predicting hospitalized bronchiectasis exacerbation risks and disease severity

“…One of the more readily available blood biomarkers that has been studied in bronchiectasis is NLR, which is calculated by dividing the number of neutrophils by the number of lymphocytes. There have been studies suggesting the role of NLR in bronchiectasis, mainly in prognostication ( 34 ).…”

Baseline neutrophil-to-lymphocyte ratio as a predictor of response to hospitalized bronchiectasis exacerbation risks

“…There was also a higher number of comorbidities (Charlson comorbidity index) and infections with Pseudomonas aeruginosa and other micro-organism s . NLR correlated more strongly with severity scores than other systemic inflammatory biomarkers such as blood neutrophil count, C-reactive protein (CRP) and fibrinogen [ 17 ]. In the same study, NLR was a predictor of the incident number and severity of exacerbations [ 17 ].…”