Neutrophil-to-lymphocyte ratio, calprotectin and YKL-40 in patients with chronic obstructive pulmonary disease: correlations and 5-year mortality – a cohort study

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation and progressive decline in pulmonary function. Neutrophil-to-lymphocyte ratio (NLR), YKL-40 and calprotectin are biomarkers of inflammation and predict mortality in patients with different inflammatory diseases. We aimed to investigate the correlation between levels of these three biomarkers and neutrophil granulocyte and lymphocyte count in patients with moderate to very severe COPD stratified by use of systemic glucocorticoids. Furthermore, we studied the ability of these biomarkers to predict all-cause mortality.Methods386 patients with moderate to very severe COPD were followed prospectively for 10 years. Patients were divided into two groups according to systemic glucocorticoid use at baseline. Correlations between biomarkers were assessed by Spearman’s Rho, and mortality was evaluated in uni- and multivariate Cox regression analyses with hazard ratios (HR) and 95% confidence intervals (CI).ResultsPlasma calprotectin was positively correlated with neutrophil granulocyte count and NLR. No significant association was found between plasma YKL-40 and the cellular biomarkers, irrespective of glucocorticoid treatment. In the group not treated with systemic glucocorticoids, plasma calprotectin [HR 1.002 (95% CI 1.000 – 1.004)], NLR [HR 1.090 (1.036 – 1.148)] and lymphocyte count [HR 0.667 (0.522 – 0.851)] were significantly associated with higher mortality. In the group treated with systemic glucocorticoids, higher plasma YKL-40 was significantly associated with mortality in univariate Cox regression analysis [HR 1.006 (1.003 – 1.008)].ConclusionsCalprotectin was related to neutrophil granulocyte count and NLR in patients with moderate to very severe COPD in stable phase and not in treatment with systemic glucocorticoids. Lymphopenia, higher plasma calprotectin and higher NLR were independent predictors of increased all-cause mortality in this group. Our data also suggests that treatment with systemic glucocorticoids has a significant impact on the ability of inflammatory biomarkers to predict all-cause mortality.Trial registrationClinicalTrials.gov NCT00132860.

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

“…In addition, it has been observed in their study that there is a positive correlation between NLR and CRP levels. In a prospective study where 386 mild and severe COPD patients have been followed-up for 10 years, NLR has been detected as an independent marker for elevated all-cause mortality [22]. It has been expressed in a retrospective study where 140 stable patients with COPD and 50 controls have been included that NLR could be a simple, effective and practical indicator in the early detection of metabolic syndrome [33].…”

“…It has been seen that NLR is a sign of poor prognosis in patients who have undergone cardiovascular involvement and an independent determinant of mortality in patients with acute coronary syndrome [18,19]. In addition, increased NLR in patients with COPD has been identified a marker that could be used to determine inflammation, detect acute exacerbation in early stages, and it has also been confirmed that it could be an independent marker for all-cause mortality [20][21][22].…”

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

“…CRP AUC higher than that of PLR in predicting death XIONG [53] ESR, EBR, CRP, RDW EBR higher in COPD than in controls, and in survivors than in dead patients. EBR and CRP are predictors of mortality, not ESR or RDW KUMAR [54] PLR, urea PLR significantly associated to 90-days mortality, AUC poor SALTÜRK [55] CRP, platelet/MPV CRP >50 mg·mL −1 risk factor for mortality SØRENSEN [56] Calprotectin, YKL-40 Correlation with calprotectin. In the group not treated with systemic glucocorticoids, plasma calprotectin was significantly associated with mortality.…”

“…glucocorticoid therapies adopted was conducted by SØRENSEN et al [56] in 386 patients with moderate-to-very severe stable COPD followed up for 10 years. The patients were divided into two groups according to systemic glucocorticoid use (the specific type of medications is not reported).…”

Could neutrophil to lymphocyte ratio be a prognostic predictor of relapse in patients with extra-pulmonary tuberculosis?

“…reported that NLR had the potential to be a sensitive prognostic marker of breast cancer (15). Furthermore, several previous studies showed that NLR was significantly associated with higher mortality (16) and correlated with higher risk of exacerbation (17) in chronic obstructive pulmonary disease patients. On the other hand, NLR was identified as a potential marker representing the disease severity in bacterial infections and predicting unfavorable outcomes, such as urinary tract infection (18), chronic hepatitis B (19) and sepsis (20).…”