The Importance of Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease

Abstract

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation and systemic inflammation. Recently, neutrophil-to-lymphocyte ratio (NLR) has gathered increasing interest in the detection of inflammation in inflammatory diseases. This study aimed to investigate the role of NLR in COPD for identifying the detection of inflammation and recognition of acute exacerbation. MATERIAL AND METHODS:The laboratory results of 103 COPD patients were included into the study, of which 47 patients were in acute exacerbation and 56 patients were at stable period, and there were 40 gender and age-matched healthy controls. Complete blood count (CBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated. NLR was calculated from CBC. RESULTS:NLR values of patients with COPD (both acutely exacerbated and stable) were found significantly higher than those of the controls (p< 0.001, p< 0.05; respectively). In all patients with COPD, NLR values positively correlated with serum CRP (r= 0.641, p< 0.001) and ESR (r= 0.276, p= 0.005) levels and negatively correlated with forced vital capacity (r= -0.20, p= 0.043) and forced expiratory volume in the 1 st second (r= -0.288, p= 0.003). For an NLR cutoff of 3.34, sensitivity for detecting exacerbation of COPD was 78.7% and specificity was 73.2% (AUC 0.863, p< 0.001). CONCLUSION:Our results suggest that NLR may be considered as a reliable and simple indicator in the determination of increased inflammation in patients with COPD. Furthermore, NLR could be useful for the early detection of possible acute exacerbations in patients with COPD.

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

“…All these studies included patients with stable COPD and AECOPD, whereas healthy controls were only enrolled in the two retrospective studies by BILIR et al [42] and IN et al [43]. These studies confirmed significantly higher NLR values in COPD patients when compared to healthy controls, whereas AECOPD patients had significantly higher NLR values when compared to patients with stable COPD.…”

“…CRP AUC was better than that of NLR, which was better than AUC for PLR BILIR [42] CRP Significant positive correlation with CRP. CRP AUC better than AUC for NLR IN [43] CRP, ESR Significant positive correlation with CRP and ESR TANRIVERDI [44] CRP, PCT PCT higher in infections. Significant but weak positive correlation with CRP.…”

“…Three further studies, one prospective and two retrospective, were conducted in Turkey [41][42][43]. All these studies included patients with stable COPD and AECOPD, whereas healthy controls were only enrolled in the two retrospective studies by BILIR et al [42] and IN et al [43].…”

“…A positive correlation with CRP was observed in all studies. The NLR cut-off points predicting exacerbation in these studies were 3.3, 3.34 and 3.35, respectively [41][42][43].…”

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

“…Leukocyte count, its subtypes, C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are the well‐known and most commonly used markers of inflammation. Besides these well‐known parameters, data from several recent studies showed that neutrophil to lymphocyte ratio (NLR) can reflect the imbalance between neutrophils and lymphocytes in patients as a representative index of systemic inflammation . The circulating leukocytes increase as a response to stress while the lymphocyte count decreases so the ratio of the subgroups, neutrophil count and lymphocyte count, exceeds.…”