The Combination of Hemogram Indexes to Predict Exacerbation in Stable Chronic Obstructive Pulmonary Disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammatory processes, and exacerbation of COPD represents a critical moment in the progression of COPD. Several biomarkers of inflammation have been proposed to have a predictive function in acute exacerbation. However, their use is still limited in routine clinical practice. The purpose of our study is to explore the prognostic efficacy of novel inflammatory hemogram indexes in the exacerbation among stable COPD patients.Method: A total of 275 stable COPD patients from the Shanghai COPD Investigation Comorbidity Program were analyzed in our study. Blood examinations, especially ratio indexes like platelet–lymphocyte ratio (PLR), platelet × neutrophil/lymphocyte ratio [systemic immune-inflammation index (SII)], and monocyte × neutrophil/lymphocyte ratio [systemic inflammation response index (SIRI)], lung function test, CT scans, and questionnaires were performed at baseline and routine follow-ups. Clinical characteristics and information of exacerbations were collected every 6 months. The relationship between hemogram indexes and diverse degrees of exacerbation was assessed by logistic regression. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the ability of hemogram indexes to predict exacerbation of COPD. Furthermore, the discrimination and accuracy of combined indexes were measured by ROC and calibration curve.Result: There was a significant positive correlation between PLR levels and total exacerbation of COPD patients in a stable stage in a year. Also, the predictive ability of PLR exceeded any other ratio indexes, with an AUC of 0.66. SII and SIRI ranked second only to PLR, with an AUC of 0.64. When combining PLR with other indexes (sex, COPD year, and St. George's Respiratory Questionnaire scores), they were considered as the most suitable panel of index to predict total exacerbation. Based on the result of the ROC curve and calibration curve, the combination shows optimal discrimination and accuracy to predict exacerbation events in COPD patients.Conclusion: The hemogram indexes PLR, SII, and SIRI were associated with COPD exacerbation. Moreover, the prediction capacity of exacerbation was significantly elevated after combining inflammatory hemogram index PLR with other indexes, which will make it a promisingly simple and effective marker to predict exacerbation in patients with stable COPD.

Neutrophil Counts, Neutrophil-to-Lymphocyte Ratio, and Systemic Inflammatory Response Index (SIRI) Predict Mortality after Off-Pump Coronary Artery Bypass Surgery

“…The inflammatory markers, including the earlier cells, appear to accurately distinguish the prognostic factors of hematologic response to immune system activation. The proposed SIRI marker is less widely explored than the more commonly used NLR [ 88 , 89 , 90 , 91 , 92 ].…”

The systemic-immune-inflammation index predicts the recurrence of atrial fibrillation after cryomaze concomitant with mitral valve surgery

“…For this post hoc analysis, the inflammatory indexes were determined based on values of monocytes (M), neutrophils (N), lymphocytes (L), and/or platelets (P) in patients received surgical ablation at indicated data: SII defined as P × N/L, NLR defined as N/L, platelet-lymphocyte ratio (PLR) defined as P/L, lymphocyte to monocyte ratio (LMR) defined as L/M, monocytes-NLR (MNLR) defined as M × N/L, monocytes-PLR (MPLR) defined as M × P/L [ 14 , 18 , 19 ].…”

Association of baseline parameters with year 0 and year 1 acute exacerbations in male patients with chronic obstructive pulmonary disease

“…Systemic immune–inflammation index (SII) was calculated as follows: platelet count × neutrophil count/lymphocyte count. 8 The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte count. Systemic inflammation response index (SIRI) was calculated as neutrophil count × monocyte count/lymphocyte count.…”

“…Systemic inflammation response index (SIRI) was calculated as neutrophil count × monocyte count/lymphocyte count. 8 …”