The utility of inflammatory markers to predict readmissions and mortality in COPD cases with or without eosinophilia

Abstract

BackgroundCOPD exacerbations requiring hospitalization increase morbidity and mortality. Although most COPD exacerbations are neutrophilic, approximately 10%–25% of exacerbations are eosinophilic.AimWe aimed to evaluate mortality and outcomes of eosinophilic and non-eosinophilic COPD exacerbations and identify new biomarkers that predict survival.MethodsA retrospective observational cohort study was carried out in a tertiary teaching hospital from January 1, 2014 to November 1, 2014. All COPD patients hospitalized with exacerbations were enrolled in the study at their initial hospitalization and followed-up for 6 months after discharge. Electronic data were collected from the hospital database. Subjects’ characteristics, hemogram parameters, CRP levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-mean platelet volume ratio on admission and discharge, length of hospital stay (days), readmissions, and mortality were recorded. Patients were grouped according to peripheral blood eosinophil (PBE) levels: Group 1, >2% PBE, eosinophilic; Group 2, non-eosinophilic ≤2%. Patient survival after hospital discharge was evaluated by Kaplan–Meier survival analysis.ResultsA total of 1,704 patients hospitalized with COPD exacerbation were included. Approximately 20% were classified as eosinophilic. Six-month mortality was similar in eosinophilic and non-eosinophilic groups (14.2% and 15.2%, respectively); however, the hospital stay length and readmission rate were longer and higher in the non-eosinophilic group (P<0.001 and P<0.01, respectively). CRP and NLR were significantly higher in the non-eosinophilic group (both P<0.01). The platelet-to-mean platelet volume ratio was not different between the two groups. Cox regression analysis showed that survival was negatively influenced by elevated CRP (P<0.035) and NLR (P<0.001) in the non-eosinophilic group.ConclusionNon-eosinophilic patients with COPD exacerbations with high CRP and NLR values had worse outcomes than eosinophilic patients. PBE and NLR can be helpful markers to guide treatment decisions.

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

“…A similar retrospective observational cohort study was conducted by DUMAN et al [50] in 1704 COPD patients hospitalised with exacerbations (351 patients with eosinophilic COPD as previously defined). Similarly, the NLR on admission was significantly higher in the non-eosinophilic group (6.0 (3.65-10.6)) in comparison to the eosinophilic group (3.73 (2.6-5.15)).…”

“…Addition of PCT to CRP increased specificity for bacterial AECOPD compared to CRP alone YASAR [47] CRP, RDW, MPV, PDW CRP, RDW and PDW were higher while MPV was lower in COPD. CRP, RDW and PDW were higher and MPV was lower in patients who had metabolic syndrome LEE [49] CRP CRP was higher in exacerbations than in healthy controls DUMAN [50] CRP, platelet/MPV CRP was significantly higher in the non-eosinophilic group. The platelet/MPV ratio was not different between the two groups.…”

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

“…It has also been evaluated as a prognostic indicator in these patients, with the results being divergent in both cases. Considering mortality, the authors did not observe differences with respect to the BEC, and others mention a lower mortality with a higher BEC . On analysing the exacerbations, most authors did not observe any differences with respect to the BEC, although some do refer to a higher overall incidence with an elevated BEC, but less mild exacerbations …”

Can N-terminal pro B-type natriuretic peptide, neutrophil-to-lymphocyte ratio, C-reactive protein help to predict short and long term mortality?

“…NT-proBNP may offer potential advantages over clinical scores and biomarkers, as it is reliable and easy to measure (12). Recent studies mention NLR as a new infl ammatory marker in exacerbation of chronic obstructive pulmonary diseases and in prognosis of lung cancer, colorectal cancer and acute coronary syndrome (13)(14)(15)(16)(17).…”