Relationship between neutrophil–lymphocyte ratio and short-term prognosis in the chronic obstructive pulmonary patients with acute exacerbation

Abstract

We retrospectively collected data from a large sample size of population and explore the relationship between neutrophil–lymphocyte ratio (NLR) and adverse outcomes, and assessed the clinical prognostic utility of NLR in patients with chronic obstructive pulmonary patients with acute exacerbation (AECOPD). We reviewed 3 years medical case records, 622 patients were identified including 48 died and 574 alive. Compared with alive group, the died group had significantly elevated neutrophils, lymphocyte, and NLR level (P<0.001). The high-sensitive C-protein level of died group was also higher compared with alive group (7.48 ± 4.2 vs 1.26 ± 0.56, vs P<0.001). The univariate logistic regression indicated that elevated NLR level was associated with the increased of adverse outcome (odds ratio [OR] = 4.59, 95% CI: 2.27–8.94, P<0.001). After adjusted potential confounding factors, the elevated NLR level was still associated with adverse outcomes in the chronic obstructive pulmonary patients with acute exacerbation (OR = 2.05, 95% CI: 1.21–3.48, P=0.008). The area under the receiver operating characteristic curve for death at 90 days was 0.742 (95% CI: 0.554–0.881). NLR cutoff of >4.19 had a sensitivity of 71.4% and specificity of 74.2%. Our results suggested that NLR, as a rapid, inexpensive and easily obtained blood routine index was associated with short-term adverse outcomes in patients with AECOPD. The elevated NLR predicted the increased the risk of 90-day mortality in patients with AECOPD.

A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Of them, 926 were excluded because they were either duplicates or irrelevant. Following a full-text review of the remaining 18 articles, a further 3 were excluded because they did not fulfill the inclusion criteria, leaving 15 articles for final analysis ( Figure 1 and Table 1 ) [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. In all studies, the NLR was assessed within the first 24–48 h of admission.…”

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

“…Researchers have found that NLR has inverse relationship with air ow limitation [24] and associated with the severity and exacerbation of COPD [25]. It can not only predict COPD progression and outcomes, but also an independent predictor of COPD mortality [9][10][11][12]. In the other hand, Emine Aksoy et al [26] showed NLR levels were higher in patients with lower eosinophil counts, who also had higher mortality and higher use of corticosteroids.…”

“…Studies have showed that some of the blood biomarkers such as in ammatory medium and chemotactic factors may have diagnostic and prognostic value of COPD and its exacerbation [8]. Recently, researchers have found that neutrophil-to-lymphocyte ratio(NLR) can not only predict COPD progression and outcomes, but also an independent predictor of COPD mortality [9][10][11][12]. Bilirubin is also con rmed to be a protective index that associated with a lower rate of COPD progression and risk of exacerbation [13].…”

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

“…Moreover, it was observed that symptoms and quality of life deteriorated with the increase of NLR [17]. Neutrophil to lymphocyte ratio had also successfully predicted the mortality of patients with COPD exacerbations [18][19][20][21][22]. However, only two groups of researchers evaluated an association between NLR and clinically useful modified Medical Research Council (mMRC) dyspnoea score or COPD multicomponent BODE index [23,24].…”