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Shen HC, Wang CH, Yang CW, Lin YH, Yeh HY, Perng DW, Yang YY, Hou MC. Elevated neutrophil-to-lymphocyte ratio combined with decreased lymphocyte-to-monocyte ratio is associated with increased peripheral airway resistance in patients with hepatic steatosis. Medicine (Baltimore) 2024; 103:e38530. [PMID: 38941417 DOI: 10.1097/md.0000000000038530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Although the link between hepatic steatosis and lung function has been confirmed, the focus has largely been on central airways. The association between hepatic steatosis and increased peripheral airway resistance has not yet been explored. Hepatic steatosis and increased peripheral resistance are connected with immunity dysregulation. High neutrophil-to-lymphocyte ratio (NLR) and low lymphocyte-to-monocyte ratio (LMR) have been recognized as indicators of immunity dysregulation. In this study, the association between hepatic steatosis and increased peripheral airway resistance was evaluated, and the effect of immunity dysregulation (high NLR/low LMR) on the increased peripheral airway resistance among patients with hepatic steatosis was explored. In this retrospective study, chest or abdomen CT scans and spirometry/impulse oscillometry (IOS) from 2018 to 2019 were used to identify hepatic steatosis and increased central/peripheral airway resistance in patients. Among 1391 enrolled patients, 169 (12.1%) had hepatic steatosis. After 1:1 age and abnormal ALT matching was conducted, clinical data were compared between patients with and without hepatic steatosis. A higher proportion of patients with hepatic steatosis had increased peripheral airway resistance than those without hepatic steatosis (52.7% vs 40.2%, P = .025). Old age, high body mass index, history of diabetes, and high NLR/low LMR were significantly correlated with increased peripheral airway resistance. The presence of hepatic steatosis is associated with increased peripheral airway. High NLR/low LMR is an independent associated factor of increased peripheral airway resistance in patients with hepatic steatosis. It is advisable for patients with hepatic steatosis to regularly monitor their complete blood count/differential count and undergo pulmonary function tests including IOS.
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Affiliation(s)
- Hsiao-Chin Shen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Chest, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hsiang Wang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Wen Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Yun Yeh
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Tung NWH, Edmondson C, Westrupp N, Rosenthal M, Davies JC. Neutrophil-to-lymphocyte ratio as a biomarker of acute pulmonary exacerbations in children with cystic fibrosis: a retrospective cohort study. Arch Dis Child 2024:archdischild-2024-327056. [PMID: 38876505 DOI: 10.1136/archdischild-2024-327056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Neutrophils are key contributors to chronic airway inflammation in cystic fibrosis (CF) lung disease, although airway and blood-based neutrophil markers are seldom used. The neutrophil-to-lymphocyte ratio (NLR) is an accessible biomarker, the clinical utility of which has not been adequately studied. OBJECTIVE This study aimed to investigate the characteristics of the NLR in children with CF and its correlations with acute pulmonary exacerbations and spirometry. DESIGN A previous study had collected clinical data from children with CF for a 3-year period between 2016 and 2021. Retrospectively, NLR values were categorised according to patients' clinical status during blood sample collection as 'stable', 'acute pulmonary exacerbation' or 'elective admission for chronic clinical concern'. MAIN OUTCOME MEASURES Demographic characteristics associated with the NLR; changes in NLR values in relation to clinical status; relationship between NLR and lung function. RESULTS 141 children with CF were included. NLR values during clinical stability were higher in females and increased with age. For children admitted for intravenous antibiotics, NLR values significantly increased from clinical stability (median (IQR)=1.13 (0.75-1.51)) to acute pulmonary exacerbations (median (IQR)=1.50 (0.96-2.65), p=0.001), but similar changes were not observed in elective admissions. The NLR was not associated with lung function. CONCLUSIONS The NLR demonstrated associations with clinical status in children with CF with significant elevations during acute pulmonary exacerbations. While its utility as a single-marker measure is limited, monitoring the NLR over time may help identify periods of increased inflammation.
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Affiliation(s)
| | - Claire Edmondson
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicole Westrupp
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mark Rosenthal
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jane C Davies
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Huang Y, Hu B, Chen S, Jiang Z, Dai Z, Jiang Z, Liu C, Xu Y, Chen X, Jin W, Yu B, Zhang X. The role of serum chloride ion in the prognosis of COPD. Am J Med Sci 2024:S0002-9629(24)01221-7. [PMID: 38777153 DOI: 10.1016/j.amjms.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND As exacerbations of chronic obstructive pulmonary disease (COPD) are one of the leading causes of hospitalization and are associated with significant mortality, it is particularly important to accurately assess the risk of exacerbations in COPD. Most of the current clinical biomarkers are related to inflammation and few consider how ion levels affect COPD. Chloride ion, the second most abundant serum electrolyte, has been shown to be associated with poor prognoses in several diseases, but their relationship with COPD remains unclear. METHODS In total, 105 patients with acute exacerbations of COPD were recruited. Data on clinical characteristics, lung function, blood count, blood biochemistry, relevant scales including the Clinical COPD Questionnaire (CCQ), BODE (BMI, airflow obstruction, dyspnea, exercise capacity) index and the St. George's Respiratory Questionnaire (SGRQ) were collected from all patients for statistical analysis. RESULT There were significant differences in lung function indicators and disease severity in the low chloride ion subgroup compared with the high chloride ion subgroup. On multiple logistic regression analysis, chloride ion was an independent factor affecting lung function in COPD patients (OR = 0.808, 95% CI: 0.708 - 0.922, p = 0.002). The sensitivity of chloride ion in predicting COPD severity was 78%, the specificity was 63%, and the area under the curve was 0.734 (p < 0.001). Subgroup analysis showed that chloride ion was a stronger predictor in male and smoking patients. CONCLUSIONS Chloride ion was a novel prognostic biomarker for COPD, and low levels of chloride ion were independently associated with exacerbations in COPD patients.
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Affiliation(s)
- Yiben Huang
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Binbin Hu
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Siyao Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Zerui Jiang
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Zicong Dai
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Zihan Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chunyan Liu
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yage Xu
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianjing Chen
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wanzhong Jin
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Yu
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaodiao Zhang
- Department of Respiratory and Critical Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Lan CC, Su WL, Yang MC, Chen SY, Wu YK. Predictive role of neutrophil-percentage-to-albumin, neutrophil-to-lymphocyte and eosinophil-to-lymphocyte ratios for mortality in patients with COPD: Evidence from NHANES 2011-2018. Respirology 2023; 28:1136-1146. [PMID: 37655985 DOI: 10.1111/resp.14589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE This study evaluated the predictive roles of hematologic inflammatory biomarkers including neutrophil-percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR) for mortality in community-dwelling individuals with chronic obstructive pulmonary disease (COPD). METHODS This longitudinal study extracted data of adults 40-79 years who had physician-diagnosed COPD from the United States (US) National Health and Nutrition Examination Survey (NHANES) 1999-2018. Cox regressions determined the associations between NPAR, NLR, ELR and their components, with all-cause mortality, cardiovascular disease (CVD) mortality and mortality from chronic lower respiratory disease (CLRD). Receiver operating characteristic (ROC) curve analysis estimated the predictive performances of these biomarkers for 5-year all-cause mortality. RESULTS Data of 1158 subjects were analysed. After adjustment, higher NPAR was significantly associated with increased all-cause and CVD mortality, and mortality from CLRD (adjusted hazard ratio [aHR] = 1.14, 1.15 and 1.16). Higher NLR was associated with an increased all-cause and CVD mortality (aHR = 1.16 and 1.29). Higher neutrophil was associated with increased all-cause mortality and mortality from CLRD (aHR = 1.13 and 1.34). Albumin was associated with decreased all-cause and CVD mortality (aHR = 0.91 and 0.86). ELR, eosinophil or lymphocyte was not significantly associated with either mortality outcomes. Adjusted AUC of NPAR and NLR in predicting 5-year all-cause mortality were 0.808 (95% CI: 0.722-0.845) and 0.799 (95% CI: 0.763-0.835), respectively. CONCLUSION In community-dwelling US adults with COPD, increased NPAR and NLR are associated with mortality risks. NPAR outperforms the other hematologic inflammatory biomarkers in predicting 5-year all-cause mortality.
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Affiliation(s)
- Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Wen-Lin Su
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Sin-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
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Leung C, Sin DD. NLR in CBC: A holy grail for biomarker research in COPD? Respirology 2023; 28:1095-1097. [PMID: 37696582 DOI: 10.1111/resp.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
See related article
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Affiliation(s)
- Clarus Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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García-Escobar A, Vera-Vera S, Tébar-Márquez D, Rivero-Santana B, Jurado-Román A, Jiménez-Valero S, Galeote G, Cabrera JÁ, Moreno R. Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: New insights for a potential predictor of anti-cytokine therapy responsiveness. Microvasc Res 2023; 150:104598. [PMID: 37633337 DOI: 10.1016/j.mvr.2023.104598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
In the 20th century, research focused on cholesterol and lipoproteins as the key mechanism in establishing atherosclerotic cardiovascular disease (ASCVD). Given that some studies demonstrated subclinical atherosclerosis in subjects without conventional cardiovascular risk factors, the elevated low-density lipoprotein (LDL) levels alone cannot account for the entire burden of atherosclerosis. Hence, large-scale clinical trials demonstrated the operation of immune and inflammatory pathways in ASCVD. In this regard, the evidence establishes that cells of the immune system, both the innate (neutrophils, macrophages) and adaptive (T cell and other lymphocytes) limbs, contribute to atherosclerosis and atherothrombosis. Besides, basic science studies have identified proatherogenic cytokines such as interleukin (IL)-1, IL-12, and IL-18. In this regard, some studies showed that antiinflammatory therapy targeting the immune system by modulating or blocking interleukins, also known as anti-cytokine therapy, can reduce the risk of major cardiovascular adverse events. The neutrophils play a key role in the innate immune system, representing the acute phase of an inflammatory response. In contrast, lymphocytes represent the adaptive immune system and promote the induction of autoimmune inflammation, especially in the chronic inflammatory response. Through the literature review, we will highlight the inflammatory pathway for the physiopathology of ASCVD, HF, and COVID-19. In this regard, the neutrophil-to-lymphocyte ratio (NLR) integrates the innate immune and adaptive immune systems, making the NLR a biomarker of inflammation. In addition, we provided an update on the evidence showing that high NLR is associated with worse prognosis in heart failure (HF), ASCVD, and COVID-19, as well as their clinical applications showing that the normalization of NLR after anti-cytokine therapy is a potential predictor of therapy responsiveness and is associated with reduction of major adverse cardiovascular events.
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Affiliation(s)
- Artemio García-Escobar
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain; Cardiology Department, Quirónsalud University Hospital Madrid, Spain.
| | - Silvio Vera-Vera
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Daniel Tébar-Márquez
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Borja Rivero-Santana
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Alfonso Jurado-Román
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | | | - Raúl Moreno
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
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Grassano M, Manera U, De Marchi F, Cugnasco P, Matteoni E, Daviddi M, Solero L, Bombaci A, Palumbo F, Vasta R, Canosa A, Salamone P, Fuda G, Casale F, Mazzini L, Calvo A, Moglia C, Chiò A. The role of peripheral immunity in ALS: a population-based study. Ann Clin Transl Neurol 2023; 10:1623-1632. [PMID: 37482930 PMCID: PMC10502618 DOI: 10.1002/acn3.51853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Systemic inflammation has been proposed as a relevant mechanism in amyotrophic lateral sclerosis (ALS). Still, comprehensive data on ALS patients' innate and adaptive immune responses and their effect on the clinical phenotype are lacking. Here, we investigate systemic immunity in a population-based ALS cohort using readily available hematological indexes. METHODS We collected clinical data and the complete blood count (CBC) at diagnosis in ALS patients from the Piemonte and Valle d'Aosta Register for ALS (PARALS) from 2007 to 2019. Leukocytes populations, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic-immune-inflammation index (SII), and lymphocyte-to-monocyte ratio (LMR) were derived from CBC. All variables were analyzed for association with clinical features in the entire cohort and then in sex- and age-based subgroups. RESULTS Neutrophils (P = 0.001) and markers of increased innate immunity (NLR, P = 0.008 and SII, P = 0.006) were associated with a faster disease progression. Similarly, elevated innate immunity correlated with worse pulmonary function and shorter survival. The prognosis in women also correlated with low lymphocytes (P = 0.045) and a decreased LMR (P = 0.013). ALS patients with cognitive impairment exhibited lower monocytes (P = 0.0415). CONCLUSIONS AND RELEVANCE The dysregulation of the systemic immune system plays a multifaceted role in ALS. More specifically, an elevated innate immune response is associated with faster progression and reduced survival. Conversely, ALS patients with cognitive impairment showed a reduction in monocyte count. Additionally, immune response varied according to sex and age, thus suggesting that involved immune pathways are patient specific. Further studies will help translate those findings into clinical practice or targeted treatments.
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Affiliation(s)
- Maurizio Grassano
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Umberto Manera
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
- SC Neurologia 1UAOU Città della Salute e della Scienza of TorinoTurinItaly
| | - Fabiola De Marchi
- Department of Neurology and ALS CentreUniversity of Piemonte Orientale, Maggiore della Carità HospitalNovaraItaly
| | - Paolo Cugnasco
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Enrico Matteoni
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Margherita Daviddi
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Luca Solero
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Alessandro Bombaci
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Francesca Palumbo
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Rosario Vasta
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Antonio Canosa
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
- SC Neurologia 1UAOU Città della Salute e della Scienza of TorinoTurinItaly
| | - Paolina Salamone
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Giuseppe Fuda
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Federico Casale
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
| | - Letizia Mazzini
- Department of Neurology and ALS CentreUniversity of Piemonte Orientale, Maggiore della Carità HospitalNovaraItaly
| | - Andrea Calvo
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
- SC Neurologia 1UAOU Città della Salute e della Scienza of TorinoTurinItaly
| | - Cristina Moglia
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
- SC Neurologia 1UAOU Città della Salute e della Scienza of TorinoTurinItaly
| | - Adriano Chiò
- ALS Centre, Department of Neuroscience “Rita Levi Montalcini”University of TorinoTurinItaly
- SC Neurologia 1UAOU Città della Salute e della Scienza of TorinoTurinItaly
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Qiu W, He H, Fan L, Feng X, Li M, Dong C, Li Z, Liu W, Liang R, Zhang Y, Zhang Y, Gu P, Wang B, Chen W. Ambient temperature exposure causes lung function impairment: The evidence from Controlled Temperature Study in Healthy Subjects (CTSHS). Int J Hyg Environ Health 2023; 252:114214. [PMID: 37392524 DOI: 10.1016/j.ijheh.2023.114214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The effect of non-optimal ambient temperatures (low and high temperatures) on lung function and the underlying mechanisms remains unclear. METHODS Forty-three (20 males, 23 females) healthy non-obese volunteers with an average of 23.9 years participated in the controlled temperature study. All volunteers underwent three temperature exposures in a sequence (moderate [18 °C], low [6 °C], and high [30 °C] temperatures) lasting 12 h with air pollutants controlled. lung function parameters (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and peak expiratory flow [PEF]) were determined in each exposure. Blood and urine samples were collected after each exposure and assayed for inflammatory markers [C-reactive protein (CRP), procalcitonin (PCT), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR)] and oxidative damage markers [protein carbonylation (PCO), 4-hydroxy-2-nominal-mercapturic acid (HNE-MA), 8-iso-prostaglandin-F2α (8-isoPGF2α), and 8-hydroxy-2-deoxyguanosine (8-OHdG)]. Mixed-effects models were constructed to assess the changes of the above indexes under low or high temperatures relative to moderate temperature, and then the repeated measures correlation analyses were performed. RESULTS Compared with moderate temperature, a 2.20% and 2.59% net decrease in FVC, FEV1, and a 5.68% net increase for PEF were observed under low-temperature exposure, while a 1.59% net decrease in FVC and a 7.29% net increase in PEF under high-temperature exposure were found (all P < 0.05). In addition, low temperature elevated inflammatory markers (PCT, PLR, and NLR) and oxidative damage markers (8-isoPGF2α, 8-OHdG), and high temperature elevated HNE-MA. Repeated measures correlation analyses revealed that PCT (r = -0.33) and NLR (r = -0.31) were negatively correlated with FVC and HNE-MA (r = -0.35) and 8-OHdG (r = -0.31) were negatively correlated with the FEV1 under low-temperature exposure (all P < 0.05). CONCLUSION Non-optimal ambient temperatures exposure alters lung function, inflammation, and oxidative damage. Inflammation and oxidative damage might be involved in low temperature-related lung function reduction.
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Affiliation(s)
- Weihong Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China; Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Heng He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Lieyang Fan
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xiaobing Feng
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Minjing Li
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Chaoqian Dong
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Zhenzhen Li
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Wei Liu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ruyi Liang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yingdie Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yongfang Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Pei Gu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Hee Jo E, Eun Moon J, Han Chang M, Jin Lim Y, Hyun Park J, Hee Lee S, Rae Cho Y, Cho AE, Pil Pack S, Kim HW, Crowley L, Le B, Nukhet AB, Chen Y, Zhong Y, Zhao J, Li Y, Cha H, Hoon Pan J, Kyeom Kim J, Hyup Lee J. Sensitization of GSH synthesis by curcumin curtails acrolein-induced alveolar epithelial apoptosis via Keap1 cysteine conjugation: A randomized controlled trial and experimental animal model of pneumonitis. J Adv Res 2023; 46:17-29. [PMID: 35772713 PMCID: PMC10105072 DOI: 10.1016/j.jare.2022.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Epidemiological studies have reported an association between exposures to ambient air pollution and respiratory diseases, including chronic obstructive pulmonary disease (COPD). Pneumonitis is a critical driving factor of COPD and exposure to air pollutants (e.g., acrolein) is associated with increased incidence of pneumonitis. OBJECTIVES Currently available anti-inflammatory therapies provide little benefit against respiratory diseases. To this end, we investigated the preventive role of curcumin against air pollutant-associated pneumonitis and its underlying mechanism. METHODS A total of 40 subjects was recruited from Chengdu, China which is among the top three cities in terms of respiratory mortality related to air pollution. The participants were randomly provided either placebo or curcumin supplements for 2 weeks and blood samples were collected at the baseline and at the end of the intervention to monitor systemic markers. In our follow up mechanistic study, C57BL/6 mice (n = 40) were randomly allocated into 4 groups: Control group (saline + no acrolein), Curcumin only group (curcumin + no acrolein), Acrolein only group (saline + acrolein), and Acrolein + Curcumin group (curcumin + acrolein). Curcumin was orally administered at 100 mg/kg body weight once a day for 10 days, and then the mice were subjected to nasal instillation of acrolein (5 mg/kg body weight). Twelve hours after single acrolein exposure, all mice were euthanized. RESULTS Curcumin supplementation, with no noticeable adverse responses, reduced circulating pro-inflammatory cytokines in association with clinical pneumonitis as positive predictive while improving those of anti-inflammatory cytokines. In the pre-clinical study, curcumin reduced pneumonitis manifestations by suppression of intrinsic and extrinsic apoptotic signaling, which is attributed to enhanced redox sensing of Nrf2 and thus sensitized synthesis and restoration of GSH, at least in part, through curcumin-Keap1 conjugation. CONCLUSIONS Our study collectively suggests that curcumin could provide an effective preventive measure against air pollutant-enhanced pneumonitis and thus COPD.
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Affiliation(s)
- Eun Hee Jo
- Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, Republic of Korea; Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea
| | - Ji Eun Moon
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; BK21 FOUR Research Group for Omics-based Bio-health in Food Industry, Korea University, Sejong, Republic of Korea; Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea
| | - Moon Han Chang
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; BK21 FOUR Research Group for Omics-based Bio-health in Food Industry, Korea University, Sejong, Republic of Korea; Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea
| | - Ye Jin Lim
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; Health Functional Food Policy Division, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, Republic of Korea
| | - Jung Hyun Park
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; Division of Brain Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Suk Hee Lee
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea
| | - Young Rae Cho
- Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea; Department of Bioinformatics, Korea University, Sejong, Republic of Korea
| | - Art E Cho
- Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea; Department of Bioinformatics, Korea University, Sejong, Republic of Korea
| | - Seung Pil Pack
- Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea; Department of Bioinformatics, Korea University, Sejong, Republic of Korea
| | | | - Liana Crowley
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Brandy Le
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Aykin-Burns Nukhet
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yinfeng Chen
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Yihang Zhong
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, China
| | - Jiangchao Zhao
- Department of Animal Science, University of Arkansas, Fayetteville, AR, USA
| | - Ying Li
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, Foshan University, Foshan, China
| | - Hanvit Cha
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; BK21 FOUR Research Group for Omics-based Bio-health in Food Industry, Korea University, Sejong, Republic of Korea; Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea
| | - Jeong Hoon Pan
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Jae Kyeom Kim
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA.
| | - Jin Hyup Lee
- Department of Food and Biotechnology, Korea University, Sejong, Republic of Korea; BK21 FOUR Research Group for Omics-based Bio-health in Food Industry, Korea University, Sejong, Republic of Korea; Biological Clock-based Anti-aging Convergence RLRC, Korea University, Sejong, Republic of Korea; Institutes of Natural Sciences, Korea University, Sejong, Republic of Korea.
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10
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Peripheral Neutrophil-to-Lymphocyte Ratio in Bronchiectasis: A Marker of Disease Severity. Biomolecules 2022; 12:biom12101399. [PMID: 36291608 PMCID: PMC9599714 DOI: 10.3390/biom12101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Most patients with bronchiectasis have a predominantly neutrophilic inflammatory profile, although other cells such as lymphocytes (as controllers of bronchial inflammation) and eosinophils also play a significant pathophysiological role. Easy-to-interpret blood biomarkers with a discriminative capacity for severity or prognosis are needed. The objective of this study was to assess whether the peripheral neutrophil-to-lymphocyte ratio (NLR) is associated with different outcomes of severity in bronchiectasis. A total of 1369 patients with bronchiectasis from the Spanish Registry of Bronchiectasis were included. To compare groups, the sample was divided into increasing quartiles of NLR ratio. Correlations between quantitative variables were established using Pearson's P test. A simple linear regression (with the value of exacerbations as a quantitative variable) was used to determine the independent relationship between the number and severity of exacerbations and the NLR ratio. The area under the curve (AUC)-ROC was used to determine the predictive capacity of the NLR for severe bronchiectasis, according to the different multidimensional scores. Mean age: 69 (15) years (66.3% of women). The mean NLR was 2.92 (2.03). A higher NLR was associated with more severe bronchiectasis (with an especially significant discriminative power for severe forms) according to the commonly used scores (FACED, E-FACED and BSI), as well as with poorer quality of life (SGRQ), more comorbidities (Charlson index), infection by pathogenic microorganisms, and greater application of treatment. Furthermore, the NLR correlated better with severity scores than other parameters of systemic inflammation. Finally, it was an independent predictor of the incident number and severity of exacerbations. In conclusion, the NLR is an inexpensive and easy-to-measure marker of systemic inflammation for determining severity and predicting exacerbations (especially the most severe) in patients with bronchiectasis.
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11
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Sadeghi F, Sarkady F, Zsóri KS, Szegedi I, Orbán-Kálmándi R, Székely EG, Vasas N, Berényi E, Csiba L, Bagoly Z, Shemirani AH. High Neutrophil-Lymphocyte Ratio and Low Lymphocyte-Monocyte Ratio Combination after Thrombolysis Is a Potential Predictor of Poor Functional Outcome of Acute Ischemic Stroke. J Pers Med 2022; 12:1221. [PMID: 35893315 PMCID: PMC9332832 DOI: 10.3390/jpm12081221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Ischemic stroke is one of the leading causes of death and disability. An inflammatory response is observed in multiple stages of cerebral ischemia, particularly in the acute phase. Recent publications revealed that the neutrophil−lymphocyte ratio (NLR) and lymphocyte−monocyte ratio (LMR) may be used to predict long-term prognosis in acute ischemic stroke (AIS) after thrombolysis. To test whether there is a relationship between the combination of these parameters and long-term prognosis, we analyzed the NLR−LMR combination in AIS patients treated with intravenous recombinant tissue plasminogen activator (rtPA); (2) Methods: The study included 285 adults with a diagnosis of AIS and rtPA treatment within a 4.5 h time window. Blood samples were obtained at admission and 24 h after thrombolysis to calculate pre- and post-thrombolysis NLR and LMR. Clinical data, including NIHSS was registered on admission and day 1. The long-term outcome was defined 90 days post-event by the modified Rankin Scale (mRS). Therapy-associated intracranial hemorrhage (ICH) was classified according to ECASS II. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs of NLR and LMR as predictors of therapy outcomes; (3) Results: Patients were stratified by cutoffs of 5.73 for NLR and 2.08 for LMR. The multivariate logistic regression model, including all possible confounders, displayed no significant association between NLR or LMR with 3-months functional prognosis. The combination of high NLR−low LMR vs. low NRL−high LMR as obtained 24 h after thrombolysis was found to be an independent predictor of poor 3-months functional outcome (mRS ≥ 2; OR 3.407, 95% CI 1.449 to 8.011, p = 0.005). The proportion of patients between low NLR−high LMR and high NLR−low LMR groups from admission to day 1 showed no significant change in the good outcome group. On the other hand, in the poor outcome group (mRS ≥ 2), low NLR−high LMR and high NLR−low LMR groups displayed a significant shift in patient proportions from 67% and 21% at admission (p = 0.001) to 36% and 49% at 24 h after thrombolysis (p < 0.001), respectively; (4) Conclusions: Our study demonstrated for the first time that a high NLR−low LMR combination as observed at 24 h after thrombolysis can serve as an independent predictor of 3-months poor outcome in AIS patients. This simple and readily available data may help clinicians to improve the prognostic estimation of patients and may provide guidance in selecting patients for personalized and intensified care post-thrombolysis.
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Affiliation(s)
- Farzaneh Sadeghi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
| | - Ferenc Sarkady
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
| | - Katalin S. Zsóri
- Central Pharmacy, Szent Borbála Hospital, 2800 Tatabánya, Hungary;
| | - István Szegedi
- Doctoral School of Neuroscience, Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.S.); (N.V.)
| | - Rita Orbán-Kálmándi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
| | - Edina G. Székely
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
| | - Nikolett Vasas
- Doctoral School of Neuroscience, Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.S.); (N.V.)
| | - Ervin Berényi
- Department of Radiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (E.B.); (L.C.)
| | - László Csiba
- Department of Radiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (E.B.); (L.C.)
- ELKH-DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
- ELKH-DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Amir H. Shemirani
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (F.S.); (F.S.); (R.O.-K.); (E.G.S.); (Z.B.)
- Central Laboratory, Szent Borbála Hospital, 2800 Tatabanya, Hungary
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12
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Pellicori P, McConnachie A, Carlin C, Wales A, Cleland JGF. Predicting mortality after hospitalisation for COPD using electronic health records. Pharmacol Res 2022; 179:106199. [DOI: 10.1016/j.phrs.2022.106199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
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13
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Rojas-Quintero J, Polverino F. Tweaking lung inflammation in COPD: the "mirky" ways of miRNAs. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1089-L1090. [PMID: 34730035 PMCID: PMC8715016 DOI: 10.1152/ajplung.00435.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Joselyn Rojas-Quintero
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francesca Polverino
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
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14
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Kotha NV, Voora RS, Qian AS, Kumar A, Qiao EM, Stewart TF, Rose BS, Orosco RK. Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer. Biomark Insights 2021; 16:11772719211049848. [PMID: 34658619 PMCID: PMC8512256 DOI: 10.1177/11772719211049848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: Neutrophil-lymphocyte ratio has been explored as a prognosticator in several
cancer types, but its association with larynx cancer outcomes is not well
known. We aimed to identify an optimal NLR cutoff point and examine the
prognostic utility of this biomarker in patients with locoregionally
advanced larynx cancer treated with curative intent. Methods: In the Veterans Affairs’ (VA) national database, we identified patients with
locoregionally advanced (T3-4N0-3M0) laryngeal squamous cell carcinoma
diagnosed between 2000 and 2017 and treated with curative intent. NLR cutoff
points were calculated using Contal/O’Quigley’s method. Outcomes of larynx
cancer-specific survival (CSS), overall survival (OS), and non-larynx cancer
survival (NCS) were evaluated in multivariable Cox and Fine-Gray models. Results: In 1047 patients, the optimal pretreatment NLR cutoff was identified as 4.17
- 722 patients with NLR ⩽ 4.17, 325 patients with NLR > 4.17. The
elevated NLR cohort had a higher proportion of T4 disease (39.4% vs 28.4%),
node positive disease (52.3% vs 43.1%), and surgical treatment (43.7% vs
35.2%). In multivariable analysis, NLR > 4.17 was independently
associated with worse OS (HR 1.31, 95% CI 1.12-1.54,
P = .001) and worse CSS (HR 1.46, 95% CI 1.17-1.83,
P < .001), but not with NCS (HR 0.94, 95% CI
0.75-1.18, P = .58). Conclusion: In locoregionally advanced larynx cancer treated with curative intent, we
identified elevated NLR to be associated with inferior OS and CSS. Further
prospective studies are needed to investigate pretreatment NLR and our
identified 4.17 cutoff as a potential larynx cancer-specific marker for this
high risk population.
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Affiliation(s)
- Nikhil V Kotha
- School of Medicine, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rohith S Voora
- School of Medicine, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, La Jolla, CA, USA
| | - Alex S Qian
- School of Medicine, University of California San Diego, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Edmund M Qiao
- School of Medicine, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Tyler F Stewart
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Moores Cancer Center at University of California San Diego Health, La Jolla, CA, USA
| | - Brent S Rose
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA.,Moores Cancer Center at University of California San Diego Health, La Jolla, CA, USA
| | - Ryan K Orosco
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, La Jolla, CA, USA.,Moores Cancer Center at University of California San Diego Health, La Jolla, CA, USA
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15
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Verheyen VJ, Remy S, Govarts E, Colles A, Rodriguez Martin L, Koppen G, Voorspoels S, Bruckers L, Bijnens EM, Vos S, Morrens B, Coertjens D, De Decker A, Franken C, Den Hond E, Nelen V, Covaci A, Loots I, De Henauw S, Van Larebeke N, Teughels C, Nawrot TS, Schoeters G. Urinary Polycyclic Aromatic Hydrocarbon Metabolites Are Associated with Biomarkers of Chronic Endocrine Stress, Oxidative Stress, and Inflammation in Adolescents: FLEHS-4 (2016-2020). TOXICS 2021; 9:toxics9100245. [PMID: 34678941 PMCID: PMC8537433 DOI: 10.3390/toxics9100245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants of public health concern. Multiple biological mechanisms have been hypothesized to contribute to PAHs-associated adverse health effects. Little is known about the impact of PAHs on endocrine stress and inflammation in adolescence. We examined 393 Flemish adolescents (14-15 years) cross-sectionally, measured urinary concentrations of hydroxylated naphthalene, fluorene, phenanthrene and pyrene metabolites, and calculated the sum of all measured metabolites. We determined hair cortisol concentration (HCC) as endocrine stress biomarker, leucocyte counts and neutrophil-lymphocyte ratio (NLR) in peripheral blood as inflammatory biomarkers, and urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) concentration as oxidative stress biomarker. Exposure-response associations were analyzed by multiple regression, adjusted for a priori selected covariates. A doubling of 1-hydroxypyrene concentration was associated with a factor of 1.13 (95% CI: 1.03, 1.24) increase in HCC and a factor of 1.07 (95% CI: 1.02, 1.13) increase in 8-oxodG. Doublings of 2- and 3-hydroxyphenanthrene concentrations were associated with a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.00, 1.12) increase in 8-oxodG, respectively. Doubling of 2-hydroxyphenanthrene and of the sum of 2- and 3-hydroxyfluorene was associated with, respectively, a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.01, 1.13) increase in NLR. Our results indicate the glucocorticoid pathway as a potential target for PAH exposure in adolescents and suggest oxidative stress, endocrine stress, and inflammation in adolescence as underlying mechanisms and early markers for PAH-related adverse health effects.
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Affiliation(s)
- Veerle J. Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
- Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
- Correspondence:
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
| | - Ann Colles
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
| | - Laura Rodriguez Martin
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
| | - Stefan Voorspoels
- VITO GOAL, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium;
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium;
| | - Esmée M. Bijnens
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; (E.M.B.); (S.V.); (T.S.N.)
| | - Stijn Vos
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; (E.M.B.); (S.V.); (T.S.N.)
| | - Bert Morrens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000 Antwerp, Belgium; (B.M.); (D.C.); (I.L.)
| | - Dries Coertjens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000 Antwerp, Belgium; (B.M.); (D.C.); (I.L.)
| | - Annelies De Decker
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000 Antwerp, Belgium; (A.D.D.); (C.F.); (E.D.H.); (V.N.)
| | - Carmen Franken
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000 Antwerp, Belgium; (A.D.D.); (C.F.); (E.D.H.); (V.N.)
| | - Elly Den Hond
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000 Antwerp, Belgium; (A.D.D.); (C.F.); (E.D.H.); (V.N.)
| | - Vera Nelen
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000 Antwerp, Belgium; (A.D.D.); (C.F.); (E.D.H.); (V.N.)
| | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Ilse Loots
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000 Antwerp, Belgium; (B.M.); (D.C.); (I.L.)
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium;
| | - Nicolas Van Larebeke
- Analytical, Environmental and Geo-Chemistry, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Department of Radiotherapy and Experimental Cancerology, Ghent University, B-9000 Ghent, Belgium
| | - Caroline Teughels
- Flemish Planning Bureau for the Environment and Spatial Development, Koning Albert II laan 20, bus 8, 1000 Brussels, Belgium;
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; (E.M.B.); (S.V.); (T.S.N.)
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (S.R.); (E.G.); (A.C.); (L.R.M.); (G.K.); (G.S.)
- Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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16
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Chang DY, Wang JW, Chen M, Zhang LX, Zhao MH. Association between serum uric acid level and mortality in China. Chin Med J (Engl) 2021; 134:2073-2080. [PMID: 34320567 PMCID: PMC8439999 DOI: 10.1097/cm9.0000000000001631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China. METHODS The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality. RESULTS During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04-1.67), 1.17 (95% CI 0.92-1.47), and 1.55 (95% CI 1.24-1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00-2.18), 1.17 (95% CI 0.79-1.75), and 1.67 (95% CI 1.16-2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99-2.08). CONCLUSIONS The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.
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Affiliation(s)
- Dong-Yuan Chang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Lu-Xia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing 100034, China
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing 100034, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing 100034, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
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Kotha NV, Cherry DR, Bryant AK, Nalawade V, Stewart TF, Rose BS. Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point. Clin Transl Radiat Oncol 2021; 28:133-140. [PMID: 33997320 PMCID: PMC8089768 DOI: 10.1016/j.ctro.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022] Open
Abstract
Neutrophil-lymphocyte ratio is a promising prognostic marker for several cancers. NLR is not useful as a marker of lung cancer survival in localized lung cancer. NLR has potential as a marker of competing mortality risk in localized lung cancer. NLR cutoff of 4.0 is proposed as a clinically useful cutoff point.
Background and purpose Neutrophil-lymphocyte ratio (NLR) has been associated with overall survival (OS) in non-small cell lung cancer (NSCLC). We aimed to assess the utility of NLR as a predictor of lung cancer-specific survival (LCS) and identify an optimal, pretreatment cutoff point in patients with localized NSCLC treated with stereotactic body radiotherapy (SBRT) within the Veterans Affairs’ (VA) national database. Materials and methods In the VA database, we identified patients with biopsy-proven, clinical stage I NSCLC treated with SBRT between 2006 and 2015. Cutoff points for NLR were calculated using Contal/O’Quigley’s and Cox Wald methods. Primary outcomes of OS, LCS, and non-lung cancer survival (NCS) were evaluated in Cox and Fine-Gray models. Results In 389 patients, optimal NLR cutoff was identified as 4.0. In multivariable models, NLR > 4.0 was associated with decreased OS (HR 1.44, p = 0.01) and NCS (HR 1.68, p = 0.01) but not with LCS (HR 1.32, p = 0.09). In a subset analysis of 229 patients with pulmonary function tests, NLR > 4.0 remained associated with worse OS (HR 1.51, p = 0.02) and NCS (HR 2.18, p = 0.01) while the association with LCS decreased further (HR 1.22, p = 0.39). Conclusion NLR was associated with worse OS in patients with localized NSCLC treated with SBRT; however, NLR was only associated with NCS and not with LCS. Pretreatment NLR, with a cutoff of 4.0, offers potential as a marker of competing mortality risk which can aid in risk stratification in this typically frail and comorbid population. Further studies are needed to validate pretreatment NLR as a clinical tool in this setting.
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Affiliation(s)
- Nikhil V Kotha
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Daniel R Cherry
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Alex K Bryant
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Tyler F Stewart
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.,Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
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Huang Y, Wang J, Shen J, Ma J, Miao X, Ding K, Jiang B, Hu B, Fu F, Huang L, Cao M, Zhang X. Relationship of Red Cell Index with the Severity of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:825-834. [PMID: 33814906 PMCID: PMC8010121 DOI: 10.2147/copd.s292666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/22/2021] [Indexed: 01/12/2023] Open
Abstract
Background We aimed to investigate the association between red cell index (RCI) and the severity of Chronic Obstructive Pulmonary Disease (COPD), and compare predictive value of RCI, neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) for the severity of COPD. Methods A total of 207 participants were recruited (100 COPD patients and 107 healthy controls). COPD patients were divided into two groups according to the optimal cut-off value of RCI determined by the receiver operating characteristic (ROC) curve. Pearson’s correlation test, logistic regression analysis and other tests were performed. Results Compared with low RCI group, the forced expiration volume in 1 second (FEV1) and FEV1 in percent of the predicted value (FEV1%) in high RCI group were lower (p = 0.016, p = 0.001). There was a negative correlation between RCI and FEV1% (r = −0.302, p = 0.004), while no correlation between FEV1% and NLR as well as PLR were found. RCI showed higher predictive value than NLR and PLR for predicting Global Initiative for Chronic Obstructive Lung Disease classification (GOLD), with a cut-off value of 1.75 and area under the curve (AUC) of 0.729 (p = 0.001). Multivariate logistic regression analysis proved that RCI was an independent factor for lung function in COPD patients (odds ratio [OR] = 4.27, 95% CI: 1.57–11.63, p = 0.004). Conclusion RCI is a novel biomarker that can better assess pulmonary function and severity of COPD than NLR and PLR. Higher RCI is related to deterioration of pulmonary function.
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Affiliation(s)
- Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiamin Shen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiedong Ma
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Bingqian Jiang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Binbin Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fangyi Fu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Lingzhi Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Meiying Cao
- Department of Cardiology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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