Neutrophil-to-lymphocyte ratio predicts clinical outcome of severe acute exacerbation of COPD in frequent exacerbators

Abstract

Frequent exacerbators are a specific phenotype of chronic obstructive pulmonary disease (COPD), whose clinical characteristics and prognostic biomarkers during severe acute exacerbation (AECOPD) have not yet been fully elucidated. The aim of this study was to investigate the clinical features of severe AECOPD in frequent exacerbators and explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for outcome in this phenotype during severe exacerbation. Patients and Methods: A total of 604 patients with severe AECOPD were retrospectively included in the study. Subjects were defined as frequent exacerbators if they experienced two or more exacerbations in the past year. Clinical characteristics and worse outcome (ICU admission, or invasive ventilation, or in-hospital mortality) during severe AECOPD were compared between frequent exacerbators and non-frequent ones. Furthermore, the relationship between NLR and worse outcome in frequent exacerbators was analyzed using logistic regression and receiver operating characteristic (ROC). Results: Among 604 patients with severe AECOPD, 282 (46.69%) were frequent exacerbators and 322 (53.31%) were non-frequent exacerbators. Compared with the non-frequent ones, frequent exacerbators presented higher levels of NLR (5.93 [IQR,; p<0.001), and more worse outcome incidence (58 [20.57%] vs 38 [11.80%]; p=0.003). Moreover, among the frequent exacerbators, NLR levels in the patients with worse outcome were much higher than in those without worse outcome (11.09 [IQR,]; p<0.001). Increased NLR was significantly associated with a higher risk of worse outcome in frequent exacerbators (OR, 1.43; 95% CI, p<0.001). Furthermore, ROC analysis revealed that a cut-off value of 10.23, NLR could predict worse outcome of severe AECOPD in frequent exacerbators (sensitivity 62.1%, specificity 92.0%, AUC 0.833). Conclusion:Frequent exacerbators exhibited an increased level of NLR and a higher proportion of worse outcome during severe AECOPD. NLR is expected to be a promising predictive biomarker for the prognosis of severe AECOPD in frequent exacerbators.

Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: present and future

“…Studies describing the association between the NLR and clinical outcomes in AECOPD have been published between 2017 and 2022. Outcomes investigated included mortality (12 studies) [25][26][27][28][29][30][31][32][33][34][35][36], ICU transfer (one study) [30], need for invasive ventilation (one study) [30], noninvasive ventilation failure (one study) [37], pulmonary hypertension (one study) [38], length of hospitalisation (one study) [39] and composite end-points (three studies) [40][41][42]. One study investigated three outcomes separately [30].…”

High level of neutrophil to lymphocyte ratio increases the risk of deep venous thrombosis in intensive care unit patients after oral cancer surgery: a retrospective study

“…Another study (28) indicated that NLR is increased in sepsis patients and is significantly correlated with sepsis severity evaluated by the sequential organ failure assessment (SOFA) score. The same study (28) indicated that NLR plays a role in prediction of severity and prognosis of patients with bloodstream infections (29) and is also predictive of a worse outcome of severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in frequent exacerbators with a cutoff value of 10.23 (30). In our study, we discovered that compared with the non-DVT group, the MVT and LOS were longer in the DVT group, moreover, the NLR level was positively related with MVT (r=0.36; P<0.001) and LOS (r=0.452; P<0.0001).…”

Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease

“…In addition, NLR has been shown to be an independent predictor of prognosis in patients with COPD [25,27] . Studies have reported that NLR is significantly higher in patients with COPD exacerbation [25,26] . There are studies stating that NLR > 10.23 is associated with poor prognosis in COPD exacerbation, a cutoff value of 10,345 can predict the need for invasive ventilation, and NLR > 16 is an independent mortality risk factor in patients requiring intensive care [26,28,29] .…”

“…NLR, especially as a prognostic biomarker, has received increasing attention in many inflammatory diseases. [25,26] In addition, NLR has been shown to be an independent predictor of prognosis in patients with COPD. [25,27] Studies have reported that NLR is significantly higher in patients with COPD exacerbation.…”

“…[25,27] Studies have reported that NLR is significantly higher in patients with COPD exacerbation. [25,26] There are studies stating that NLR > 10.23 is associated with poor prognosis in COPD exacerbation, a cutoff value of 10,345 can predict the need for invasive ventilation, and NLR > 16 is an independent mortality risk factor in patients requiring intensive care. [26,28,29] In our study, the cut-off value of NLR was determined as 7.972 in terms of nutritional risk assessment in patients hospitalized in the intensive care unit due to COPD (AUC = 0.351, sensitivity 56.4%, specificity 67.7%, P < .001).…”