Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review

Abstract

COPD is characterized by a pulmonary and systemic inflammatory process. Several authors have reported the elevation of multiple inflammatory markers in patients with COPD; however, their use in routine clinical practice has limitations. The neutrophil-to-lymphocyte ratio (NLR) is a useful and cost-effective inflammatory marker derived from routine complete blood count. We performed a systematic literature review using the PRISMA statement. Twenty-two articles were included, recruiting 7,601 COPD patients and 784 healthy controls. Compared with controls, COPD patients had significantly higher NLR values. We found a significant correlation between the NLR and clinical/functional parameters (FEV1, mMRC, and BODE index) in COPD patients. Elevation of the NLR is associated with the diagnosis of acute exacerbation of COPD (pooled data propose a cut-off value of 3.34 with a median sensitivity, specificity, and area under the curve of 80%, 86%, and 0.86, respectively). Additionally, increased NLR is also associated with the diagnosis of a bacterial infection in exacerbated patients, with a cut-off value of 7.30, although with a low sensitivity and specificity. The NLR is an independent predictor of in-hospital and late mortality after exacerbation. In conclusion, the NLR could be a useful marker in COPD patients; however, further studies are needed to better identify the clinical value of the NLR.

Correlatıon of neutrophyle/lymphocyte ratio and pulmonary parameters with optic coherence tomography findings in stable chronic obstructive pulmonary disease

“…Physiological response of circulating leukocytes to stress factors is an increase in numbers of neutrophils and a relatively lower count of lymphocytes and the ratio between these two subgroups (neutrophil‐to‐lymphocyte ratio—NLR) has been recently used to monitor the process of inflammation in many diseases such as lung cancer, colorectal cancer, end‐stage renal disease and acute coronary syndrome . Calculating NLR is easy and rapid since only complete blood count is needed.…”

“…14 Physiological response of circulating leukocytes to stress factors is an increase in numbers of neutrophils and a relatively lower count of lymphocytes and the ratio between these two subgroups (neutrophil-to-lymphocyte ratio-NLR) has been recently used to monitor the process of inflammation in many diseases such as lung cancer, colorectal cancer, end-stage renal disease and acute coronary syndrome. [16][17][18][19][20][21][22] Calculating NLR is easy and rapid since only complete blood count is needed. The test is based on the physiological response of circulating leukocytes to precipitating stress factors, with increased numbers of neutrophils and fewer lymphocytes, resulting in an increased NLR in periods of inflammation.…”

The role of inflammatory parameters (neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and monocyte‐to‐eosinophil ratio) in patients with Peyronie's disease

“…demonstrated the usefulness of NLR to discriminate patients with pulmonary tuberculosis from patients with bacterial community‐acquired pneumonia (Yoon et al ., ). Another study showed that elevation of the NLR is associated with the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (Pascual‐González et al ., ). Sunbul et al .…”

Comparison of complete blood counts of stable COPD patients at two different altitude in Turkey.

“…Chronic obstructive pulmonary disease (COPD) is a global health problem and the third leading cause of mortality worldwide. 1,2 COPD is a common disease characterized by improperly reversible airflow limitation and alveolar abnormalities. 1,2 The most important risk factors for COPD are smoking, air pollution, age, tuberculosis exposure, socioeconomic status and additionally geographical differences.…”

“…1,2 COPD is a common disease characterized by improperly reversible airflow limitation and alveolar abnormalities. 1,2 The most important risk factors for COPD are smoking, air pollution, age, tuberculosis exposure, socioeconomic status and additionally geographical differences. 3 Around 400 million people live in high altitude (>1500 meters above sea-level) and this geographical altitude is associated with COPD prevalence, and adaptation mechanism of these patients.…”