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Li X, Shang H, Tang Q, Guo L, Li Z. Relationship between neutrophil lymphocyte ratio and red blood cell distribution width and respiratory failure in COPD patients. Medicine (Baltimore) 2024; 103:e38512. [PMID: 38875435 PMCID: PMC11175887 DOI: 10.1097/md.0000000000038512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/18/2024] [Accepted: 05/17/2024] [Indexed: 06/16/2024] Open
Abstract
The neutrophil lymphocyte ratio (NLR) and red blood cell distribution width (RDW) have been repeatedly demonstrated to be associated with risk of severity, progression, and prognosis of chronic obstructive pulmonary disease (COPD), but data on respiratory failure (RF) in patients with COPD are very limited. This study aimed to examine the relationship between NLR and RDW and the incident RF in patients with COPD. This is a retrospective study that reviewed data by examining the hospitalization medical records to identify those who were admitted with a diagnosis of COPD. Based on whether RF occurred during index hospitalization, patients were classified as COPD group and COPD combined with RF group. Also, healthy controls of the same age and sex were enrolled in a 1:1 ratio as the COPD group. Univariate comparisons were performed between three groups to examine differences. With the COPD group as reference, multivariable logistic regression was formed to identify the relationship between NLR and RDW and RF, with adjustment for multiple covariates. There were 136 healthy controls, 136 COPD patients and 62 patients with COPD combined with RF included for analysis. There was a significant difference for eight variables, including age, WBC, neutrophil, NLR, RDW, platelet, PLR, and CRP. The Spearman test showed the significant correlation between NLR and WBC (correlation coefficient, 0.38; P = .008), NLR and RDW (correlation coefficient, 0.32; P = .013), and NLR and CRP level (correlation coefficient, 0.54; P < .001). The multivariable logistic regression showed that age (every additional 10 years) (OR, 1.785), NLR (OR, 1.716), RDW (OR, 2.266), and CRP (OR, 1.163) were independently associated with an increased risk of RF. This study demonstrated the independent associative effect of NLR and RDW with RF in patients with COPD, exhibiting the potential clinical role in evaluating the progress of COPD to RF.
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Affiliation(s)
- Xinghong Li
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Huanxia Shang
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Qian Tang
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Lijuan Guo
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Zhensheng Li
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
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Mudenda S, Bumbangi FN, Yamba K, Munyeme M, Malama S, Mukosha M, Hadunka MA, Daka V, Matafwali SK, Siluchali G, Mainda G, Mukuma M, Hang’ombe BM, Muma JB. Drivers of antimicrobial resistance in layer poultry farming: Evidence from high prevalence of multidrug-resistant Escherichia coli and enterococci in Zambia. Vet World 2023; 16:1803-1814. [PMID: 37859964 PMCID: PMC10583887 DOI: 10.14202/vetworld.2023.1803-1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023] Open
Abstract
Background and Aim Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia. Materials and Methods This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR. Results In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems. Conclusion This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Kaunda Yamba
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Sydney Malama
- Department of Pathology and Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Scott Kaba Matafwali
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Godfrey Siluchali
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Anatomy and Physiological Sciences, Institute of Basic and Biomedical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Geoffrey Mainda
- Food and Agriculture Organization (FAO) of the United Nations, House No. 5 Chaholi, off Addis Ababa drive, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Bernard Mudenda Hang’ombe
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Hoult G, Gillespie D, Wilkinson TMA, Thomas M, Francis NA. Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis. BMC Pulm Med 2022; 22:194. [PMID: 35549921 PMCID: PMC9101830 DOI: 10.1186/s12890-022-01958-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD. Methods We searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias. Results Of 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers. Conclusions There is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01958-4.
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Affiliation(s)
- George Hoult
- Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
| | - David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital, Southampton University, Mailpoint 810, Level F, South Block, Southampton, SO16 6YD, UK.,NIHR Southampton BRC - Respiratory Theme, Faculty of Medicine, Southampton General Hospital, Southampton University, Mailpoint 810, Level F, South Block, Southampton, SO16 6YD, UK
| | - Mike Thomas
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Nick A Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK.
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Ruiz-González A, Sáez-Huerta E, Martínez-Alonso M, Bernet-Sánchez A, Porcel JM. A Simple Scoring System to Differentiate Bacterial from Viral Infections in Acute Exacerbations of COPD Requiring Hospitalization. Int J Chron Obstruct Pulmon Dis 2022; 17:773-779. [PMID: 35422620 PMCID: PMC9004675 DOI: 10.2147/copd.s356950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Agustín Ruiz-González
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLleida), University of Lleida, Lleida, Spain
| | - Eduardo Sáez-Huerta
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLleida), University of Lleida, Lleida, Spain
| | | | | | - José M Porcel
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLleida), University of Lleida, Lleida, Spain
- Correspondence: José M Porcel, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain, Email
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Sivapalan P, Jensen JU. Biomarkers in Chronic Obstructive Pulmonary Disease: Emerging Roles of Eosinophils and Procalcitonin. J Innate Immun 2021; 14:89-97. [PMID: 34428766 PMCID: PMC9082212 DOI: 10.1159/000517161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Antibiotics can improve the prognosis in patients with exacerbation of chronic obstructive pulmonary disease. However, the overuse of antibiotics can carry serious adverse effects for patients (gastrointestinal infections) and for society (bacterial resistance). Likewise, systemic corticosteroids may also help these patients, but also carries severe adverse effects like osteoporosis, muscle loss, and diabetes, in many patients. Whenever safe methods exist to reduce these two treatment modalities, they should be implemented. The blood biomarkers procalcitonin and the fraction of leukocytes known as eosinophil granulocytes have been proven in randomized controlled trials (RCTs), to effectively, significantly, and substantially assist in reducing the use of these two potent, yet toxic medication types. In this review, the background and main clinical results are discussed, explaining the rationale for biomarker-guided clinical decisions. Also, the main expected effects, their sizes, and importantly the limitations to such a strategy are described. Clinical evidence is prioritized with main weight on RCTs and meta-analyses of these and regarding outcomes, and focus is set on the safety of such a biomarker-guided strategy, as well as the effects on medicine reduction. In an epoch of increasing demands to physicians from patients and politicians to cure and reduce symptoms, the Hippocratic phrase of "primum non nocere" or "first, do no harm" seems more than ever of contemporary importance.
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Affiliation(s)
- Pradeesh Sivapalan
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jens-Ulrik Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Sun W, Luo Z, Jin J, Cao Z, Ma Y. The Neutrophil/Lymphocyte Ratio Could Predict Noninvasive Mechanical Ventilation Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2267-2277. [PMID: 34385816 PMCID: PMC8353100 DOI: 10.2147/copd.s320529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine the effectiveness of neutrophil/lymphocyte ratio (NLR), compared to traditional inflammatory markers, for predicting noninvasive mechanical ventilation (NIMV) failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Patients and Methods We conducted this retrospective observational study including 212 AECOPD patients who required NIMV during hospitalization from January 2015 to December 2020 in the department of respiratory and critical care medicine of Beijing Chao-Yang Hospital (west campus). We reviewed the medical record to determine if NIMV succeeded or failed for each patient, and compared NLR with traditional markers (leukocyte, C-reactive protein [CRP] and procalcitonin [PCT]) between NIMV failure and NIMV success group. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analysis were used to assess the accuracy of these markers for predicting NIMV failure. Results A total of 38 (17.9%) patients experienced NIMV failure. NLR was a more sensitive biomarker to predict NIMV failure (AUC, 0.858; 95% CI 0.785-0.931) than leukocyte counts (AUC, 0.723; 95% CI 0.623-0.823), CRP (AUC, 0.670; 95% CI 0.567-0.773) and PCT (AUC, 0.719; 95% CI 0.615-0.823). There was statistically positive correlation between NLR and leukocytes count (r=0.35, p<0.001), between NLR and CRP (r=0.258, p<0.001), between NLR and PCT (r=0.306, p<0.001). The cutoff value of NLR to predict NIMV failure was 8.9 with sensitivity 0.688, specificity 0.886 and diagnostic accuracy 0.868. NLR>8.9 (odds ratio, 10.783; 95% CI, 2.069-56.194; P=0.05) was an independent predictor of NIMV failure in the multivariate logistic regression model. Conclusion NLR may be an effective marker for predicting NIMV failure in AECOPD patients, and the patients with NLR>8.9 should be handled with caution since they are at higher risk of NIMV failure and require intubation. Further study with a larger sample size and with more data is necessary to confirm our study.
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Affiliation(s)
- Wei Sun
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiawei Jin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Guo R, Li J, Ma X, Pan L. The predictive value of neutrophil-to-lymphocyte ratio for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2021; 14:929-936. [PMID: 32938249 DOI: 10.1080/17476348.2020.1776613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION There was inconsistent results regarding the associations of neutrophil to lymphocyte ratio (NLR) with the progression and prognosis of chronic obstructive pulmonary disease (COPD). AREAS COVERED This paper assess the role of NLR on the progression and prognosis of COPD using a meta-analytic approach. PubMed, EmBase, and the Cochrane library were systematically searched. The pooled weighted mean differences and odds ratios with 95% confidence intervals were applied for continuous and categorical variables using the random-effects model. EXPECT COMMENATRY NLR was significantly high when comparing COPD patients to healthy individuals, and acute exacerbation COPD to stable COPD. Moreover, elevated NLR were significantly associated with higher risk of mortality and exacerbation.
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Affiliation(s)
- Rui Guo
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Jia Li
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Xiaorong Ma
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
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Li M, Yang T, He R, Li A, Dang W, Liu X, Chen M. The Value of Inflammatory Biomarkers in Differentiating Asthma-COPD Overlap from COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:3025-3037. [PMID: 33244228 PMCID: PMC7685357 DOI: 10.2147/copd.s273422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To evaluate the accuracy of inflammatory biomarkers in differentiating patients with asthma-COPD overlap (ACO) from those with COPD alone. Methods Clinical data of 134 patients with COPD and 48 patients with ACO admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to June 2019 were retrospectively analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values of fractional exhaled nitric oxide (FeNO), blood eosinophil counts (EOS), and neutrophil to lymphocyte ratio (NLR) for differentiating between ACO and COPD alone. Spearman correlation analysis was conducted to evaluate the relationships between these inflammatory biomarkers and the forced expiratory volume in one second/prediction (FEV1%pred). Results FeNO and EOS in the ACO patients were significantly higher than those in the COPD patients (FeNO: median 37.50 vs 24.50 ppb, P < 0.001; EOS: median 0.20 vs 0.10 ×109/L, P = 0.004). FeNO was positively correlated with FEV1%pred (r = 0.314, P = 0.030), while NLR was negatively correlated with FEV1%pred (r = -0.372, P = 0.009) in patients with ACO. In addition, a positive correlation between FeNO and EOS was also found in ACO, especially in patients without history of inhaled corticosteroids (ICS) use (r = 0.682, P < 0.001). The optimal cut-off value of FeNO was 31.5 ppb (AUC = 0.758, 95% CI = 0.631-0.886) in patients with smoking history, with 70.0% sensitivity and 89.9% specificity for differentiating ACO from COPD. In patients without history of ICS use, the best cut-off value of FeNO was 39.5 ppb (AUC = 0.740, 95% CI = 0.610-0.870), with 58.3% sensitivity and 84.9% specificity. Among patients without history of ICS use and smoking, 27.5 ppb was optimal cut-off level for FeNO (AUC = 0.744, 95% CI = 0.579-0.908) to diagnose ACO, with 81.8% sensitivity and 60.7% specificity, and the sensitivity was improved to 91.7% when FeNO was combined with EOS. Conclusion The inflammatory biomarkers FeNO and EOS can be used as indicators for differentiating between ACO and COPD alone.
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Affiliation(s)
- Meng Li
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Tian Yang
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Ruiqing He
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Anqi Li
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Wenhui Dang
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Xinyu Liu
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
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Vasse M, Ballester MC, Ayaka D, Sukhachev D, Delcominette F, Habarou F, Jolly E, Sukhacheva E, Pascreau T, Farfour É. Interest of the cellular population data analysis as an aid in the early diagnosis of SARS-CoV-2 infection. Int J Lab Hematol 2020; 43:116-122. [PMID: 32812365 PMCID: PMC7461522 DOI: 10.1111/ijlh.13312] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Abstract
Introduction Coronavirus disease 2019 (COVID‐19) is characterized by a high contagiousness requiring isolation measures. At this time, diagnosis is based on the positivity of specific RT‐PCR and/or chest computed tomography scan, which are time‐consuming and may delay diagnosis. Complete blood count (CBC) can potentially contribute to the diagnosis of COVID‐19. We studied whether the analysis of cellular population data (CPD), provided as part of CBC‐Diff analysis by the DxH 800 analyzers (Beckman Coulter), can help to identify SARS‐CoV‐2 infection. Methods Cellular population data of the different leukocyte subpopulations were analyzed in 137 controls, 322 patients with proven COVID‐19 (COVID+), and 285 patients for whom investigations were negative for SARS‐CoV‐2 infection (COVID−). When CPD of COVID+ were different from controls and COVID− patients, we used receiver operating characteristic analysis to test the discriminating capacity of the individual parameters. Using a random forest classifier, we developed the algorithm based on the combination of 4 monocyte CPD to discriminate COVID+ from COVID− patients. This algorithm was tested prospectively in a series of 222 patients referred to the emergency unit. Results Among the 222 patients, 86 were diagnosed as COVID‐19 and 60.5% were correctly identified using the discriminating protocol. Among the 136 COVID− patients, 10.3% were misclassified (specificity 89.7%, sensitivity 60.5%). False negatives were observed mainly in patients with a low inflammatory state whereas false positives were mainly seen in patients with sepsis. Conclusion Consideration of CPD could constitute a first step and potentially aid in the early diagnosis of COVID‐19.
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Affiliation(s)
- Marc Vasse
- Biology Department, Foch Hospital& UMR-S 1176, Suresnes and Kremlin-Bicêtre, France
| | | | | | | | | | | | - Emilie Jolly
- Biology Department, Foch Hospital, Suresnes, France
| | | | - Tiffany Pascreau
- Biology Department, Foch Hospital& UMR-S 1176, Suresnes and Kremlin-Bicêtre, France
| | - Éric Farfour
- Biology Department, Foch Hospital, Suresnes, France
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van Eeden SF, Hogg JC. Immune-Modulation in Chronic Obstructive Pulmonary Disease: Current Concepts and Future Strategies. Respiration 2019; 99:550-565. [PMID: 31480060 DOI: 10.1159/000502261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is caused by the chronic inhalation of toxic particles and gases that are primarily but not exclusively derived from cigarette smoke that may be either actively or passively inhaled, which initiates a persistent innate and adaptive immune response in the lung. This immune response is associated with an aberrant tissue repair and remodeling process that results in varying degrees of chronic inflammation with excess production of mucus in the central airways and permanent destruction of the smaller conducting airways and gas exchanging surface in the peripheral lung. Currently, the primary aims of treatment in COPD are bronchodilation (inhaled short- and long-acting β-agonist and antimuscarinic therapies), to control symptoms and nonspecific broad-acting anti-inflammatory agents (inhaled and oral corticosteroids, phosphor-di-esterase inhibitors, and macrolides). That provide symptomatic relief but have little or no impact on either disease progression or mortality. As our understanding of the immune pathogenesis of the COPD improves, available immune modulation therapies have the potential to alter or interfere with damaging immune pathways, thereby slowing relentless progression of lung tissue destruction. The purpose of this brief review is to discuss our current understanding of the immune pathogenesis of both the airways and parenchymal injury as well as the dysfunctional tissue repair process to propose immune modulating interventions in an attempt to stabilize or return these pathological changes to their normal state. The ultimate goal of the immune modulation therapy is to improve both morbidity and mortality associated with COPD.
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Affiliation(s)
- Stephan F van Eeden
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada, .,Pacific Lung Health Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada,
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Pascual-González Y, López-Sánchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review. Int J Chron Obstruct Pulmon Dis 2018; 13:3651-3662. [PMID: 30464448 PMCID: PMC6225854 DOI: 10.2147/copd.s178068] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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.
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Affiliation(s)
- Yuliana Pascual-González
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Marta López-Sánchez
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Jordi Dorca
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Salud Santos
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain, .,Biomedical Research Networking Center Consortium - Respiratory Diseases (CIBERES), Barcelona, Spain,
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12
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Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, Carru C, Zinellu A. The neutrophil-to-lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta-analysis. Eur J Clin Invest 2018; 48:e12984. [PMID: 29924383 DOI: 10.1111/eci.12984] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/19/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The main white blood cell populations, neutrophils and lymphocytes, are involved in the pathophysiology of chronic obstructive pulmonary disease (COPD). We conducted a systematic review and meta-analysis of studies investigating the relationship between the neutrophil to lymphocyte ratio (NLR, a marker of subclinical inflammation), presence of COPD, and its exacerbations. METHODS A comprehensive literature search was conducted in Pubmed, Web of Science and Scopus databases; two investigators independently reviewed suitable studies. RESULTS Nine studies, from 247 initially identified, were included in the meta-analysis. Seven studies, in 775 COPD patients with stable disease and 496 healthy controls, showed a significant increase in NLR values in stable COPD (standardised mean difference, SMD, 0.773, 95% CI 0.410-1.136; P < 0.001). Furthermore, in six studies in 527 COPD patients with acute exacerbation and 620 COPD patients with stable disease, NLR values were significantly higher in patients with exacerbations (random effects SMD 0.850, 95% CI 0.549-1.151; P < 0.001). CONCLUSIONS Our meta-analysis showed that NLR values are significantly higher in stable COPD patients when compared to healthy individuals, although the magnitude of the difference is reduced after trim and fill adjustment, and in patients with COPD exacerbations when compared to patients with stable disease. Further studies, in larger cohorts, are needed to confirm whether the NLR is a useful tool in discriminating between COPD patients with stable disease, those with acute exacerbations, and subjects without the disease.
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Affiliation(s)
| | - Alessandro G Fois
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.,Department of Respiratory Diseases, University Hospital Sassari (AOU), Sassari, Italy
| | - Salvatore Sotgia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Elisabetta Zinellu
- Department of Respiratory Diseases, University Hospital Sassari (AOU), Sassari, Italy
| | - Pietro Pirina
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.,Department of Respiratory Diseases, University Hospital Sassari (AOU), Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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13
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Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, Negri S, Carru C, Zinellu A. Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev 2018; 27:27/147/170113. [DOI: 10.1183/16000617.0113-2017] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/27/2017] [Indexed: 01/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group.
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14
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Leung JM, Tiew PY, Mac Aogáin M, Budden KF, Yong VFL, Thomas SS, Pethe K, Hansbro PM, Chotirmall SH. The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD. Respirology 2017; 22:634-650. [PMID: 28342288 PMCID: PMC7169176 DOI: 10.1111/resp.13032] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/16/2022]
Abstract
COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe-COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe-host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.
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Affiliation(s)
- Janice M. Leung
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, St Paul's HospitalUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pei Yee Tiew
- Department of Respiratory and Critical Care MedicineSingapore General HospitalSingapore
| | - Micheál Mac Aogáin
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kurtis F. Budden
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | | | - Sangeeta S. Thomas
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kevin Pethe
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Philip M. Hansbro
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
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