Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

ObjectiveThis study aimed to determine the predictive value of the neutrophil to lymphocyte ratio (NLR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsA retrospective study was conducted from March 2012 to May 2016 in Fuxing Hospital, Capital University of Medical Science. We collected 906 cases (525 males, 381 females, mean age 81.86±9.75 years) diagnosed with AECOPD. The NLR was calculated from their white blood cell (WBC), neutrophil (NEU), and lymphocyte (LYM) counts, which were obtained at laboratory examination.ResultAfter treatment, 698 patients with AECOPD improved. The NLR was higher at admission (6.89±6.82) than after treatment (4.19±5.11) (P = 0.000). The area under the receiver operating characteristic curve (AUC) of the NLR for predicting the 28-day mortality rate was 0.737. Using 8.130 as the critical NLR value, the sensitivity was 60.5%, and the specificity was 74.8%. The AUC of the NLR for predicting the frequency of the need for invasive mechanical ventilation was 0.732. Using 10.345 as the critical NLR value, the sensitivity was 54.3%, and the specificity was 84.8%. The AUC of WBC, NEU and LYM for predicting 28-day mortality and the need for invasive mechanical ventilation in these patients were all less than 0.7. An increased NLR was an independent risk factor for 28-day mortality (OR = 1.067, 95% CI = 1.039 to 1.095, P = 0.000), intensive care unit occupancy (OR = 1.046, 95% CI = 1.023 to 1.068, P = 0.000), and the need for invasive mechanical ventilation (OR = 1.042, 95% CI = 1.019 to 1.066, P = 0.000). Compared with those patients without comorbidities, patients with renal dysfunction or upper gastrointestinal bleeding had an increased risk of death within 28 days (OR = 3.102, 95% CI = 1.525 to 6.312; OR = 4.598, 95% CI = 1.825 to 11.583, respectively), ICU admission (OR = 2.228, 95% CI = 1.286 to 3.860; OR = 3.103, 95% CI = 1.402 to 6.866, respectively), and the need for invasive mechanical ventilation (OR = 3.572, 95% CI = 1.822 to 7.000; OR = 4.279, 95% CI = 1.823 to 10.045, respectively).ConclusionIn patients with AECOPD, the accuracy of the NLR for predicting the 28-day mortality rate and frequency of the need for mechanical ventilation was significantly higher than the accuracy of WBC, NEU and LYM counts. AECOPD patients with an NLR≥8.130 had higher 28-day mortality rate, while those with an NLR ≥10.345 were more likely to need invasive mechanical ventilation.

Low serum lymphocyte level is associated with poor exercise capacity and quality of life in chronic obstructive pulmonary disease

“…Although lymphocytes play a critical role in the pathogenesis of COPD involving airway and parenchymal inflammation, patients with COPD have also shown a decreased in lymphocyte counts 8 – 11 . Low lymphocyte count is one of the markers of stress response and the low ratio of lymphocyte in the peripheral blood have the potential to indicate the pathological condition of chronic inflammation 8 , 10 .…”

Diagnostic value of neutrophil to lymphocyte ratio to rule out chronic obstructive pulmonary disease exacerbation from acute heart failure in the emergency department

“…Rapid and proper recognition of these patients along with appropriate treatment may be the only action that prevents respiratory failure and mortality [11][12][13]. Currently, there is no consensus for the assessment of the severity and progression of acute COPD exacerbations by using a clinical tool [5]. Heart failure is also a critical clinical condition with findings such as dyspnoea, orthopnoea, lower limb swelling, and pulmonary congestion because of possible structural and/or functional cardiac abnor-mality with important physiological abnormalities including reduced cardiac output and/or elevated intracardiac pressures [14].…”

“…NLR has been used in patients with acute COPD exacerbation in several studies, mostly as an indicator of exacerbation. Teng et al [5] examined the predictive value of NLR in patients with acute COPD exacerbation. Their findings showed that NLR was higher in patients during admission and decreased after treatment according to clinical improvement.…”

“…The neutrophil to lymphocyte ratio (NLR) is calculated by dividing the number of neutrophils (NEU) by a number of lymphocytes (LYM) in a peripheral blood sample. The NLR is a simple parameter to assess the inflammatory status of a subject easily because it is relatively inexpensive and widely available as a part of a routine blood count analysis [5]. Furthermore, NLR has been demonstrated to be superior to routine parameters like C-reactive protein (CRP) level, white blood cell (WBC) count and NEU count in predicting bacteraemia [6].…”

The Importance of Neutrophil to Lymphocyte Ratio and Peripheral Blood Eosinophilia in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: Recent Studies

“…Fei et al [18] investigated the role of NLR in the prediction of acute exacerba-A. H. Abdinur, Y. D. Gao Open Journal of Respiratory Diseases tion in COPD patients.…”