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Ellingsen J, Janson C, Bröms K, Hårdstedt M, Högman M, Lisspers K, Palm A, Ställberg B, Malinovschi A. CRP, Fibrinogen, White Blood Cells, and Blood Cell Indices as Prognostic Biomarkers of Future COPD Exacerbation Frequency: The TIE Cohort Study. J Clin Med 2024; 13:3855. [PMID: 38999421 PMCID: PMC11242174 DOI: 10.3390/jcm13133855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objective: Systemic inflammation is common in chronic obstructive pulmonary disease (COPD), and evidence suggests that inflammatory biomarkers can predict acute exacerbations (AECOPDs). The aim of this study was to analyse whether C-reactive protein (CRP), fibrinogen, white blood cell count (WBC), or the blood cell indices PLR (platelet-to-lymphocyte ratio), SII (systemic immune inflammation index), SIRI (systemic inflammation response index), and AISI (aggregate index of systemic inflammation) can predict future AECOPDs. Methods: In the Tools Identifying Exacerbations (TIE) cohort study, participants with spirometry-confirmed COPD were recruited from primary and secondary care in three Swedish regions and assessed during a stable phase of COPD. AECOPD frequency during the three-year follow-up was reviewed in medical records. Associations were analysed via ordinal logistic regressions. Results: Of the 571 participants, 46% had ≥1 AECOPD during follow-up, and the mean ± SD AECOPD frequency was 0.63 ± 1.2/year. In unadjusted analyses, high levels of CRP (odds ratio 1.86, 95% CI 1.29-2.67), fibrinogen (2.09, 1.38-3.16), WBCs (2.18, 1.52-3.13), SII (1.52, 1.05-2.19), SIRI (1.76, 1.23-2.52), and AISI (1.99, 1.38-2.87) were associated with a higher AECOPD frequency. After adjustment for AECOPD history, age, sex, smoking, body mass index, COPD Assessment Test score, lung function, and inhaled corticosteroid use, associations remained for high levels of CRP (adjusted odds ratio of 1.64; 95% CI of 1.08-2.49), fibrinogen (1.55; 1.07-2.24), and WBC (1.65; 1.10-2.47). Conclusions: CRP, fibrinogen, and WBC, assessed during stable-phase COPD, enhanced AECOPD prediction, whereas PLR, SII, SIRI, and AISI did not.
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Affiliation(s)
- Jens Ellingsen
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, 751 85 Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, 751 85 Uppsala, Sweden
| | - Kristina Bröms
- Department of Public Health & Caring Sciences, Family Medicine & Preventive Medicine, Uppsala University, 751 85 Uppsala, Sweden
| | - Maria Hårdstedt
- Center for Clinical Research Dalarna-Uppsala University, 791 82 Falun, Sweden
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health & Caring Sciences, Family Medicine & Preventive Medicine, Uppsala University, 751 85 Uppsala, Sweden
| | - Andreas Palm
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, 751 85 Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health & Caring Sciences, Family Medicine & Preventive Medicine, Uppsala University, 751 85 Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, 751 85 Uppsala, Sweden
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Song YD, Bai XM, Ma J. The association of systemic immune-inflammation index with lung function, risk of COPD and COPD severity: A population-based study. PLoS One 2024; 19:e0303286. [PMID: 38875233 PMCID: PMC11178193 DOI: 10.1371/journal.pone.0303286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/22/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE The relationship between the levels of Systemic Immune-inflammation Index (SII) and chronic obstructive pulmonary disease (COPD), lung function, and COPD severity were not fully understood. We conducted this cross-sectional, population-based study to investigate the complex association between SII and COPD, lung function, and COPD severity among the US adults. METHODS Overall, 18,349 participants were included in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The exposure variable was SII, calculated from platelet counts, neutrophil counts, and lymphocyte counts. Weighted univariable and multivariable logistic regression, subgroup analysis, and restricted cubic spline (RCS) regression were performed to assess the relationship between COPD, lung function, COPD severity and SII. Last, we used a propensity score matching (PSM) analysis to reduce selective bias and validate these relationships. RESULTS Approximately 1,094 (5.96%) of the participants were diagnosed as COPD. The multivariable-adjusted odds ratio (OR) (95% confidence interval, CI) for the Q2 group (Log-SII > 2.740) was 1.39 (1.16 to 1.68). Before and after matching, multivariable logistic regression models revealed that increased Log-SII levels (SII Logarithmic transformation) associated positively with the risk of COPD. The subgroup analysis showed no interaction between Log-SII and a variety of variables (P for interaction > 0.05). RCS showed a reversed L-shaped relationship between Log-SII with COPD (P for nonlinear = 0.001) in individuals. In addition, we observed negative significant correlations between forced expiratory volume in one second (FEV1) / forced vital capacity (FVC) %, FEV1/FVC% predicted and SII, and reversed U-shaped curve relationships between FEV1, FEV1% predicted and SII. High SII level is associated with severity of COPD, especially at Global Initiative on Obstructive Lung Disease (GOLD) 1 and GOLD 3. CONCLUSIONS In summary, the Log-SII level is associated with COPD risk, lung function, and COPD severity.
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Affiliation(s)
- Ying-da Song
- Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
- Fifth Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, People's Republic of China
| | - Xiao-Ming Bai
- Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Jun Ma
- Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
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Yang X, Han X, Liang M, Wang Y, Zhang J, Cao J. The role of neutrophil to lymphocyte ratio in patients with COPD-OSA overlap syndrome. Sleep Breath 2024; 28:1329-1335. [PMID: 38413554 DOI: 10.1007/s11325-024-03013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE The aim of this study is to investigate the role of the neutrophil to lymphocyte ratio (NLR) in patients diagnosed with the chronic obstructive pulmonary disease-obstructive sleep apnea (COPD-OSA) overlap syndrome and comorbid pulmonary hypertension (PH). PATIENTS AND METHODS We enrolled a consecutive of stable COPD patients and conducted spirometry measurements, nocturnal polysomnography (PSG), and echocardiography for all participants. Clinical laboratory data were collected. RESULTS A total of 178 patients with stable COPD were enrolled among whom 33.14% (59/178) were diagnosed with OSA. Of the patients with overlap syndrome, 35.59% (21/59) showed comorbid PH, compared to 34.45% (41/119) in COPD patients without OSA. There was no significant difference in the occurrence of PH between COPD with and without OSA. NLR was significantly higher in patients with overlap syndrome compared to those with either disease alone. The difference in NLR between COPD-OSA patients with and without PH was not significant. Correlation analysis revealed that NLR was associated with age, total sleep time spent with oxygen saturation below 90% (T90), CRP, pulmonary artery systolic pressure (PASP), and minimum peripheral capillary oxygen saturation (SpO2min) in all COPD patients. NLR was identified as an independent factor contributing to OSA in COPD. The median cut-off value for detecting OSA in stable COPD was 2.49. However, NLR was not found to be a predictor for PH in COPD-OSA overlap syndrome. CONCLUSIONS NLR can serve as a predictive marker for comorbid OSA in patients with COPD. NLR is expected to increase its clinical application as a convenient and cost-effective biomarker for COPD-OSA overlap syndrome.
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Affiliation(s)
- Xia Yang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
| | - Xuejiao Han
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Min Liang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Jie Cao
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
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Pang X, Liu X. Immune Dysregulation in Chronic Obstructive Pulmonary Disease. Immunol Invest 2024; 53:652-694. [PMID: 38573590 DOI: 10.1080/08820139.2024.2334296] [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] [Indexed: 04/05/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease whose incidence increase with age and is characterised by chronic inflammation and significant immune dysregulation. Inhalation of toxic substances cause oxidative stress in the lung tissue as well as airway inflammation, under the recruitment of chemokines, immune cells gathered and are activated to play a defensive role. However, persistent inflammation damages the immune system and leads to immune dysregulation, which is mainly manifested in the reduction of the body's immune response to antigens, and immune cells function are impaired, further destroy the respiratory defensive system, leading to recurrent lower respiratory infections and progressive exacerbation of the disease, thus immune dysregulation play an important role in the pathogenesis of COPD. This review summarizes the changes of innate and adaptive immune-related cells during the pathogenesis of COPD, aiming to control COPD airway inflammation and improve lung tissue remodelling by regulating immune dysregulation, for further reducing the risk of COPD progression and opening new avenues of therapeutic intervention in COPD.
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Affiliation(s)
- Xichen Pang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoju Liu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
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Waseem SMA, Masood I, Siddiqui AH, Amir M, Hussain SH, Husaini SHM. Neutrophil-to-Lymphocyte Ratio and Blood Eosinophil Levels As Inflammatory Indicators in Smoker and Non-smoker Young Adult Patients With Chronic Obstructive Pulmonary Disease at a Tertiary Care Hospital. Cureus 2024; 16:e56212. [PMID: 38618443 PMCID: PMC11016197 DOI: 10.7759/cureus.56212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Inflammatory markers are elevated in chronic obstructive pulmonary disease (COPD) and can be quantified to detect severity, prognosis, mortality risk, and response to treatment. However, the estimation costs are high. The blood neutrophil-to-lymphocyte ratio (NLR) and eosinophil levels are emerging as biomarkers in COPD, yet there is a paucity of data. Aim and objectives This study was designed to elucidate the roles of the NLR and eosinophil levels in smokers and non-smokers with stable COPD male subjects, correlating them with lung functions. Materials and methods A prospective observational clinical study was conducted from January to June 2023, after receiving approval from the Institutional Ethics Committee, on 73 COPD patients aged 30-60 years who gave voluntary informed consent. Complete blood counts and spirometry were performed. Patients with a forced expiratory volume in one second (FEV1) % predicted <70% and an FEV1/forced vital capacity (FVC) % <70% based on the pulmonary function test (MIR Spirolab) were included. They were further divided into mild (n=10), moderate (n=27), severe (n=26), and very severe (n=10) categories as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Subjects were also categorized into smoker (n=45) and non-smoker (n=28) groups. The complete blood count was analyzed using an automated analyzer (Beckman Coulter). Analysis was also carried out with an NLR of more or less than three. A P-value of less than 0.05 was considered significant. Results Smokers constituted 61.65% (n=45) of the subjects, and non-smokers 38.35% (n=28). Among smokers, 17.78% had very severe airflow obstruction. In all COPD subjects (n=73), lymphocytes, eosinophils, and lung functions were lower in the group where the NLR was greater than three. NLR in smokers (3.52±1.43) was higher than in non-smokers (3.39±0.94). In non-smokers (n=28), blood eosinophils and lymphocytes were elevated. In smokers (n=45), blood neutrophils, monocytes, and basophils were increased. Smokers showed a non-significant increase in RBC, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH). Neutrophils, monocytes, eosinophils, and NLR increased with disease severity. NLR negatively correlated with FEV1 (r=-0.350, p=0.034) and positively with pack-years (r=0.546, p<0.001) in smokers. NLR negatively correlated with eosinophils, FVC, FEV1/FVC, and FEV1 % predicted. In all COPD subjects (n=73), NLR negatively correlated with blood eosinophils (r=-0.184, p=0.12), BMI, and lung functions. Conclusion NLR is elevated in COPD subjects and can serve as a marker of inflammation and a predictor of the risk and severity of airflow limitation. NLR correlates both positively and negatively with pack-years and lung functions, respectively.
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Affiliation(s)
| | - Imrana Masood
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Anwar H Siddiqui
- Physiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Mohd Amir
- Physiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Syed Hilal Hussain
- Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
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Yan LN, Chen M, Wei H, Ma HR. Construction and validation of nomogram prediction model for risk of acute heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease. Medicine (Baltimore) 2024; 103:e36840. [PMID: 38181256 PMCID: PMC10766264 DOI: 10.1097/md.0000000000036840] [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: 11/04/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
To investigate the influencing factors of in-hospital acute heart failure (AHF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct and validate a risk prediction nomogram model. Three Hundred Thirty patients with AECOPD admitted to our hospital from June 2020 to June 2023 were retrospectively analyzed as a training set for the construction of the model. Three Hundred Twenty-five AECOPD patients admitted to the Second People's Hospital of Hefei from 2006 to June 2023 were also collected as the validation set for the validation of the model. A nomogram model was constructed to predict the risk of nosocomial AHF in patients with AECOPD, and C-index and receiver operating characteristic curve were drawn to assess the predictive predictive efficacy of the model. Model fit was evaluated by Hosmer-Lemeshow test, calibration curve was drawn to evaluate the calibration of the model; decision curve was drawn to analyze the net benefit rate of this nomogram model. Multivariate logistic regression analysis indicated that body mass index, mmRC grade, neutrophils, lymphocytes, hemoglobin, creatinine, PO2, PCO2, and Homocysteine were independent risk factors for in-hospital AHF in patients with AECOPD. To construct a nomogram model for risk prediction of in-hospital AHF in patients with AECOPD. The C-index of the training set was 0.949 (95% CI: 0.91-0.961); the C-index of the validation set was 0.936 (95% CI: 0.911-0.961) suggesting good model discrimination. The receiver operating characteristic curve calculated area under curve for the training set was 0.949 (95% CI: 0.928-0.97); area under curve for the validation set was 0.936 (95% CI: 0.91-0.961) suggesting good model accuracy. The results of Hosmer-Lemeshoe goodness-of-fit test and calibration curve analysis showed that the calibration curve of this nomogram model was close to the ideal curve. The clinical decision curve also showed good clinical net benefit of the nomogram model. Body mass index, mmRC grade, neutrophils, lymphocytes, hemoglobin, creatinine, PO2, PCO2, and Homocysteine are risk factors for in-hospital AHF in AECOPD patients, and nomogram models constructed based on the above factors have some predictive value for in-hospital AHF in AECOPD patients. It is also vital for nursing staff to strengthen nursing care.
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Affiliation(s)
- Li-Na Yan
- Department of Paediatric, Fuyang Cancer Hospital, Fuyang, Anhui, China
| | - Min Chen
- Department of Cardiology, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Hui Wei
- Department of Respiratory, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Hao-Ran Ma
- Department of Respiratory, Fuyang Women and Children ‘s Hospital, Fuyang, Anhui, China
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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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Chen Z, Zha L, Feng G, An Q, Shi F, Xu J, Xu Q, Xia H, Zhang M, Li L. Prognostic Value of Serum Cholinesterase Levels for In-Hospital Mortality among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. COPD 2023; 20:178-185. [PMID: 38178805 DOI: 10.1080/15412555.2023.2209178] [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: 10/12/2022] [Accepted: 04/21/2023] [Indexed: 01/06/2024]
Abstract
Cholinesterase (ChE) is associated with the pathogenesis of chronic obstructive pulmonary disease (COPD), including chronic airway inflammation and oxidation/antioxidant imbalance. However, the relationship between serum ChE levels and survival outcomes of patients hospitalized with acute exacerbations of COPD (AECOPD) is unknown. In this retrospective single-center study, we investigated the ability of the serum ChE level to predict in-hospital death in patients hospitalized with AECOPD. The clinicopathological data, including serum ChE levels as well as clinical and biochemical indicators were extracted for 477 patients from the hospital records and analyzed. Our results demonstrated that AECOPD patients with lower serum ChE levels were associated with increased mortality, frequent hospitalization due to acute exacerbations (AE) in the past year, and longer hospital stay. The optimal cutoff value for the serum ChE level was 4323 U/L. The area under the ROC curve (AUC) values for predicting in-hospital mortality based on the serum ChE level was 0.79 (95% confidence interval (CI), 0.72-0.85). Multivariate logistic regression analysis demonstrated that serum ChE level ≤ 4323 U/L (odds ratio (OR) 9.09, 95% CI 3.43-28.3, p < 0.001), age-adjusted Charlson comorbidity index (aCCI), and the number of hospitalizations due to AE in the past year were independent risk factors for predicting the in-hospital mortality of AECOPD patients. In conclusion, our study demonstrated that low serum ChE levels were associated with significantly higher in-hospital mortality rates of patients hospitalized with AECOPD. Therefore, serum ChE level is a promising prognostic predictor of hospitalized AECOPD patients.
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Affiliation(s)
- Zhixiang Chen
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Lei Zha
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu City, Anhui Province, China
| | - Guohong Feng
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Qian An
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Fei Shi
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Jingjing Xu
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Qiancheng Xu
- cDepartment of Critical Care Medicine, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu City, Anhui Province, China
- Anhui Clinical Medicine Research Center for Critical Illness Respiratory Diseases, Wuhu City, Anhui Province, China
| | - Huimin Xia
- Postgraduate School of Wuhu Hospital of Traditional Chinese Medicine affiliated with Anhui, University of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Milan Zhang
- Postgraduate School of Wuhu Hospital of Traditional Chinese Medicine affiliated with Anhui, University of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
| | - Lu Li
- Postgraduate School of Wuhu Hospital of Traditional Chinese Medicine affiliated with Anhui, University of Traditional Chinese Medicine, Wuhu City, Anhui Province, China
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Hu HS, Wang Z, Jian LY, Zhao LM, Liu XD. Optimizing inhaled corticosteroid use in patients with chronic obstructive pulmonary disease: assessing blood eosinophils, neutrophil-to-lymphocyte ratio, and mortality outcomes in US adults. Front Immunol 2023; 14:1230766. [PMID: 38035096 PMCID: PMC10684949 DOI: 10.3389/fimmu.2023.1230766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Accurate biomarkers for evaluating mortality rates in patients with chronic obstructive pulmonary disease (COPD) remain scarce. This study aimed to explore the relationships between mortality rates in patients with COPD and blood eosinophil counts, neutrophil counts, and lymphocyte counts, along with the neutrophil-to-lymphocyte ratio (NLR). Additionally, we sought to identify the optimal response values for these biomarkers when utilizing inhaled corticosteroids (ICS). Methods Utilizing a nationally representative, multistage cross-sectional design and mortality correlation study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 involving US adults aged 40 years or older with COPD. The primary endpoint was all-cause mortality, with Kaplan-Meier survival curves and restricted cubic splines applied to illustrate the relationship between leukocyte-based inflammatory markers and mortality. The analysis was conducted in 2023. Results Our analysis included 1,715 COPD participants, representing 6,976,232 non-institutionalized US residents [weighted mean age (SE), 62.09 (0.28) years; range, 40-85 years]. Among the participants, men constituted 50.8% of the population, and the weighted mean follow-up duration was 84.9 months. In the ICS use group, the weighted proportion of participants over 70 years old was significantly higher compared with the non-ICS use group (31.39% vs 25.52%, p < 0.0001). The adjusted hazard ratios for all-cause mortality related to neutrophil counts, lymphocyte counts, and NLR were 1.10 [95% confidence interval (CI), 1.04-1.16, p < 0.001], 0.83 (95% CI, 0.71-0.98; p = 0.03), and 1.10 (95% CI, 1.05-1.15; p < 0.0001), respectively. Optimal ICS response was linked with higher levels of eosinophil count (≥240 cells/μL), neutrophil count (≥3,800 cells/μL), NLR (≥4.79), and lower levels of lymphocyte count (<2,400 cells/μL). Conclusion Adjusted baseline neutrophil, lymphocyte counts, and NLR serve as independent risk factors for all-cause mortality in patients with COPD. Further, ICS application appears to mitigate mortality risk, particularly when NLR levels reach 4.79 or higher, underlining the importance of ICS in COPD management.
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Affiliation(s)
- Han-Shuo Hu
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Zhuo Wang
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Ling-Yan Jian
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Li-Mei Zhao
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Xiao-Dong Liu
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
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Ryu MH, Yun JH, Morrow JD, Saferali A, Castaldi P, Chase R, Stav M, Xu Z, Barjaktarevic I, Han M, Labaki W, Huang YJ, Christenson S, O’Neal W, Bowler R, Sin DD, Freeman CM, Curtis JL, Hersh CP. Blood Gene Expression and Immune Cell Subtypes Associated with Chronic Obstructive Pulmonary Disease Exacerbations. Am J Respir Crit Care Med 2023; 208:247-255. [PMID: 37286295 PMCID: PMC10395718 DOI: 10.1164/rccm.202301-0085oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPDs) are associated with a significant disease burden. Blood immune phenotyping may improve our understanding of a COPD endotype at increased risk of exacerbations. Objective: To determine the relationship between the transcriptome of circulating leukocytes and COPD exacerbations. Methods: Blood RNA sequencing data (n = 3,618) from the COPDGene (Genetic Epidemiology of COPD) study were analyzed. Blood microarray data (n = 646) from the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) study were used for validation. We tested the association between blood gene expression and AE-COPDs. We imputed the abundance of leukocyte subtypes and tested their association with prospective AE-COPDs. Flow cytometry was performed on blood in SPIROMICS (Subpopulations and Intermediate Outcomes in COPD Study) (n = 127), and activation markers for T cells were tested for association with prospective AE-COPDs. Measurements and Main Results: Exacerbations were reported 4,030 and 2,368 times during follow-up in COPDGene (5.3 ± 1.7 yr) and ECLIPSE (3 yr), respectively. We identified 890, 675, and 3,217 genes associated with a history of AE-COPDs, persistent exacerbations (at least one exacerbation per year), and prospective exacerbation rate, respectively. In COPDGene, the number of prospective exacerbations in patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stage ⩾2) was negatively associated with circulating CD8+ T cells, CD4+ T cells, and resting natural killer cells. The negative association with naive CD4+ T cells was replicated in ECLIPSE. In the flow-cytometry study, an increase in CTLA4 on CD4+ T cells was positively associated with AE-COPDs. Conclusions: Individuals with COPD with lower circulating lymphocyte counts, particularly decreased CD4+ T cells, are more susceptible to AE-COPDs, including persistent exacerbations.
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Affiliation(s)
- Min Hyung Ryu
- Channing Division of Network Medicine and
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jeong H. Yun
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jarrett D. Morrow
- Channing Division of Network Medicine and
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aabida Saferali
- Channing Division of Network Medicine and
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Peter Castaldi
- Channing Division of Network Medicine and
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Meryl Stav
- Channing Division of Network Medicine and
| | | | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - MeiLan Han
- Division of Pulmonary and Critical Care Medicine and
| | - Wassim Labaki
- Division of Pulmonary and Critical Care Medicine and
| | - Yvonne J. Huang
- Division of Pulmonary and Critical Care Medicine and
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
| | - Stephanie Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, California
| | - Wanda O’Neal
- Marsico Lung Institute, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Russell Bowler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Don D. Sin
- Centre for Heart and Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine and
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Craig P. Hersh
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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11
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Feng X, Xiao H, Duan Y, Li Q, Ou X. Prognostic Value of Neutrophil to Lymphocyte Ratio for Predicting 90-Day Poor Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1219-1230. [PMID: 37337582 PMCID: PMC10276987 DOI: 10.2147/copd.s399671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
Objective This study aimed to evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) for poor outcomes within 90-day in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective study including 503 AECOPD patients was performed, and the subjects' clinical characteristics were collected. Binary logistic regression analysis was used to identify risk factors for 90-day poor outcomes in patients with AECOPD. Receiver-operating characteristic curves (ROC) and areas under the curves (AUC) were used to assess the ability of different biomarkers to predict the risk of 90-day mortality, readmission and re-exacerbation in patients with AECOPD. Results During the follow-up, 188 patients (38.4%) redeveloped exacerbations, 112 patients (22.9%) were readmitted, and 20 patients (4.1%) died directly resulted from COPD or COPD-related causes. Multivariate analysis demonstrated that age>72 years (OR: 14.817, 95% CI: 1.561-140.647), NLR>14.17 (OR: 9.611, 95% CI: 2.303-40.113), EOS<0.15% (OR: 8.621, 95% CI: 3.465-34.913) and BNP>2840ng/L (OR: 5.291, 95% CI: 1.367-20.474) at discharge were independent risk factors for 90-day mortality in AECOPD patients. NLR was the optimal biomarker for predicting 90-day mortality with an AUC of 0.802 (95% CI: 0.631-0.973). Using 14.17 as the critical value of NLR, the sensitivity was 76.7%, and the specificity was 88.9%. Compared with mortality, NLR had no significant advantage in predicting risk of short-term re-exacerbation (AUC=0.580, 95% CI:0.529-0.632, p=0.001) and readmission (AUC=0.555, 95% CI:0.497-0.614, p=0.045), with AUCs less than 0.6. In contrast, the predictive value of EOS (AUC=0.561, 95% CI:0.502-0.621, p=0.038) was slightly better than NLR in terms of readmission within 90 days. CRP did not serve as a well predictive biomarker for the risk of readmission and re-deterioration (p>0.05). Conclusion NLR is of great value in predicting the risk of poor outcomes, especially COPD associated mortality, in hospitalized patients with AECOPD within 90 days after discharge.
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Affiliation(s)
- Xiaoyi Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Huaye Xiao
- Department of Respiratory and Critical Care Medicine, Fushun People’s Hospital, Zigong, Sichuan, 643200, People’s Republic of China
| | - Yishan Duan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Qinxue Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xuemei Ou
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
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12
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Kryvoruchko IA, Staikov P, Boyko VV, Sartelli M, Ivanova YV, Honcharov A, Gramatiuk S, Sargsyan K. Physiological stress level and screening for malnutrition as preoperative predictors of postoperative complications in pancreatic surgery: a retrospective study. BMC Surg 2023; 23:156. [PMID: 37301822 DOI: 10.1186/s12893-023-02062-y] [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: 01/11/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Assessment of 'physiological stress levels' and 'nutritional status' before surgery is important for predicting complications and indirect interventions on the pancreas. The aim of this study was to determine neutrophil-lymphocyte ratio (NLR) and nutritional risk index (NRI) indicators before surgery to predict 90-day complications and mortality in a cohort of patients with complicated chronic pancreatitis and cancer of the head of the pancreas. METHODS We evaluated preoperative levels of NLR and NRI among 225 subjects treated at different centres located in three countries. Short-term outcomes included length of hospital stay, postoperative complications, and mortality at 90 days and were appreciated based on NLR and NRI. The level of physiological stress was divided according by the formulas: neutrophil-lymphocyte ratio (NLR) = (neutrophil count, %)/(lymphocyte count, %). The nutritional state of the patients was divided according to the INR: NRI = (1.519 × serum albumin, g/L) + (41.7 × present weight, kg / usual weight, kg)]. RESULTS All patients were operated. An analysis of the operations performed in three institutions demonstrated mortality in chronic pancreatitis and pancreatic pseudocysts in 1.4%, in chronic pancreatitis and the presence of an inflammatory mass mainly in the pancreatic head in 1.2%, and in cancer of the pancreatic head in 5.9%. The mean preoperative NLR was normal in 33.8% of the patients, the mild physiologic stress level was 54.7%, and the moderate was 11.5% before surgery. 10.2% of patients had a normal nutritional status, 20% had mild, 19.6% had moderate, and 50.2% had severe malnutrition. In a univariate analysis, at the cutoff of NLR ≥ 9.5 (AUC = 0.803) and the cutoff of NRI ≤ 98.5 (AUC = 0.801), increasing the risk of complications was observed (hazard ratio, 2.01; 95% CI, 1.247-3.250, p = 0.006), but at the cutoff of NRI ≤ 83.55 (AUC = 0.81), we observed a survival difference in operated patients (hazard ratio, 2.15; 95% CI, 1.334-3.477, p = 0.0025). CONCLUSIONS Our study demonstrated that NLR and NRI were predictors of postoperative complications, but only NRI was a predictor of 90-day mortality in patients after surgery.
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Affiliation(s)
- Igor A Kryvoruchko
- Department of Surgery No.2, Kharkiv National Medical University, Nezalezhnosti Avenue, Kharkiv, 61022, Ukraine.
| | - Plamen Staikov
- Department of Surgery No.2, Kharkiv National Medical University, Nezalezhnosti Avenue, Kharkiv, 61022, Ukraine
- Krankenhaus Sachsenhausen, 60594, SchulstraßeFrankfurt Am Main, Germany
| | - Valeriy V Boyko
- Institute General and Emergency Surgery Named After V.T. Zaitcev of the National Academy of Medical Sciences of Ukraine, Balakireva Entry, Kharkiv, 61103, Ukraine
- Department of Surgery No.1, Kharkiv National Medical University, Balakireva Entry, Kharkiv, 61103, Ukraine
| | - Massimo Sartelli
- Department of Surgery Macerata Hospital, Santa Lucia Street, 62100, Macerata, Italy
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Puskinska Str, Kharkiv, 61022, Ukraine
| | - Yulia V Ivanova
- Department of Surgery No.1, Kharkiv National Medical University, Balakireva Entry, Kharkiv, 61103, Ukraine
| | - Andrij Honcharov
- Department of Surgery No.2, Kharkiv National Medical University, Nezalezhnosti Avenue, Kharkiv, 61022, Ukraine
| | - Svetlana Gramatiuk
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Puskinska Str, Kharkiv, 61022, Ukraine
- International Biobanking and Education, Medical University of Graz, Elisabethstraße, 8010, Graz, Austria
| | - Karine Sargsyan
- International Biobanking and Education, Medical University of Graz, Elisabethstraße, 8010, Graz, Austria
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13
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Suzuki E, Kawata N, Shimada A, Sato H, Anazawa R, Suzuki M, Shiko Y, Yamamoto M, Ikari J, Tatsumi K, Suzuki T. Prognostic Nutritional Index (PNI) as a Potential Prognostic Tool for Exacerbation of COPD in Elderly Patients. Int J Chron Obstruct Pulmon Dis 2023; 18:1077-1090. [PMID: 37309393 PMCID: PMC10257926 DOI: 10.2147/copd.s385374] [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: 08/20/2022] [Accepted: 04/28/2023] [Indexed: 06/14/2023] Open
Abstract
Purpose In COPD, exacerbation of the disorder causes a deterioration in the quality-of-life and worsens respiratory dysfunction, leading to a poor prognosis. In recent years, nutritional indices have been reported as significant prognostic factors in various chronic diseases. However, the relationship between nutritional indicators and prognosis in elderly subjects with COPD has not been investigated. Patients and methods We enrolled 91 subjects who received COPD assessment tests (CAT), spirometry, blood tests, and multidetector computed tomography (MDCT). We divided the subjects into two groups according to age (<75 years (n=57) and ≥ 75 years (n=34)). The prognostic nutritional index (PNI) was used to assess immune-nutritional status and was calculated as 10 x serum albumin + 0.005 x total lymphocyte count. We then examined the relationship between PNI and clinical parameters, including exacerbation events. Results There was no significant correlation between the PNI and CAT, the FEV1%pred, or low attenuation volume percentage (LAV%). In the elderly group, there were significant differences between the groups with or without exacerbation in the CAT and PNI (p=0.008, p=0.004, respectively). FEV1%pred, neutrophil-to-lymphocyte ratio (NLR) and LAV% did not differ between the two groups. The analytical model combining CAT and PNI improved the prediction of exacerbations in the elderly subjects (p=0.0068). Conclusion In elderly subjects with COPD, CAT were associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in subjects with COPD.
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Affiliation(s)
- Eiko Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, 215-0026, Japan
| | - Hirotaka Sato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Radiology, Soka Municipal Hospital, Souka-shi, Saitama, 340-8560, Japan
| | - Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Infectious Diseases, NTT Medical Center Tokyo, Tokyo, 141-8625, Japan
| | - Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Kashiwa Kousei General Hospital, Kashiwa-shi, Chiba-ken, 277-8551, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba-shi, 260-8670, Japan
| | - Mayumi Yamamoto
- Department of Palliative Care Medicine, Chiba Rosai Hospital, Chiba-shi, Chiba, 290-0003, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
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Blood monocyte levels predict the risk of acute exacerbations of chronic obstructive pulmonary disease: a retrospective case-control study. Sci Rep 2022; 12:21057. [PMID: 36473925 PMCID: PMC9727121 DOI: 10.1038/s41598-022-25520-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Monocytes were critical cells in the innate immune system. Monocyte recruitment to the lungs is a crucial process of pathophysiology in chronic obstructive pulmonary disease (COPD). Current evidence on the association between the occurrence of acute exacerbations of COPD (AECOPD) and monocytes was unclear. This study aimed to examine whether blood monocytes are associated with the occurrence of AECOPD and to determine the specific blood monocyte level to predict AECOPD. A retrospective case-control study was conducted at Changhua Christian Hospital. A total of 444 eligible patients with COPD were included between January 2017 and December 2019. Restricted cubic splines were used to analyze the nonlinear relationships between continuous white blood cell values and the occurrence of AECOPD. The association between monocytes and the occurrence of AECOPD was assessed using the logistic, lasso, and ridge regression models. Restricted cubic splines revealed nonlinear associations among the monocyte level, the continuous value of the eosinophil-to-lymphocyte ratio, and the occurrence of AECOPD. The lowest risk of occurrence of AECOPD ranged from 7.4 to 10%; < 7.4% with an absolute count < 0.62 or > 10% indicated significant risk. No significant association was noted between the eosinophil-to-lymphocyte ratio categories in the tertiles (< 0.049, 0.049 to < 0.122, and ≥ 0.122) and the risk of AECOPD. A significantly higher risk was noted in the association of the occurrence of AECOPD with the CAT score; mMRC score; wheezing cough; preexisting chronic pulmonary disease; hypertension and malignancy; use of dual- and triple, and oral long-acting bronchodilators for COPD treatment; and WBC count. We reported a nonlinear relationship between monocytes and the occurrence of AECOPD. Patients with monocyte percentage of > 10% or < 7.4% with an absolute count < 0.62 had higher risk of occurrence of AECOPD. Overall, our study demonstrated the specific value of monocytes in identifying high risks of the occurrence of AECOPD; this value is an easy-to-obtain, inexpensive biomarker in patients with AECOPD and should be further investigated in future prospective clinical studies.
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15
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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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Biswas M, Suvarna R, Krishnan S V, Devasia T, Shenoy Belle V, Prabhu K. The mechanistic role of neutrophil lymphocyte ratio perturbations in the leading non communicable lifestyle diseases. F1000Res 2022; 11:960. [PMID: 36619602 PMCID: PMC9780608 DOI: 10.12688/f1000research.123245.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Inflammation plays a critical role in the development and progression of chronic diseases like type 2 diabetes mellitus, coronary artery disease, and chronic obstructive pulmonary disease. Inflammatory responses are indispensable for pathogen control and tissue repair, but they also cause collateral damage. A chronically activated immune system and the resultant immune dysregulation mediated inflammatory surge may cause multiple negative effects, requiring tight regulation and dampening of the immune response to minimize host injury. While chronic diseases are characterized by systemic inflammation, the mechanistic relationship of neutrophils and lymphocytes to inflammation and its correlation with the clinical outcomes is yet to be elucidated. The neutrophil to lymphocyte ratio (NLR) is an easy-to-measure laboratory marker used to assess systemic inflammation. Understanding the mechanisms of NLR perturbations in chronic diseases is crucial for risk stratification, early intervention, and finding novel therapeutic targets. We investigated the correlation between NLR and prevalent chronic conditions as a measure of systemic inflammation. In addition to predicting the risk of impending chronic conditions, NLR may also provide insight into their progression. This review summarizes the mechanisms of NLR perturbations at cellular and molecular levels, and the key inflammatory signaling pathways involved in the progression of chronic diseases. We have also explored preclinical studies investigating these pathways and the effect of quelling inflammation in chronic disease as reported by a few in vitro, in vivo studies, and clinical trials.
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Affiliation(s)
- Monalisa Biswas
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Renuka Suvarna
- Division of Ayurveda, Center for Integrative Medicine and Research, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vimal Krishnan S
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vijetha Shenoy Belle
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India,
| | - Krishnananda Prabhu
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India,
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Baldemir R, Cirik MÖ. Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease: Prognostic nutritional index, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratio. Medicine (Baltimore) 2022; 101:e29433. [PMID: 35713452 PMCID: PMC9276300 DOI: 10.1097/md.0000000000029433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/20/2022] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is an important condition in patients diagnosed with chronic obstructive pulmonary disease (COPD). There is a need for practical and objective nutritional assessment methods in patients hospitalized in the intensive care unit with the diagnosis of COPD. In this study, it was aimed to determine the parameters that can practically evaluate the nutritional status of these patients. It was aimed to determine the relationship between prognostic nutritional index (PNI), and nutritional risk screening (NRS)-2002, nutrition risk in the critical ill (Nutric) Score and to determine a cut-off value for PNI, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and other complete blood count parameters.Hemogram values, albumin values, NLR, PLR, LMR, NRS-2002, PNI and modified Nutric Score calculations of the patients hospitalized in the intensive care unit due to COPD were recorded. The relationship between PNI and NRS-2002 and modified Nutric Score, as well as the relationship between NLR, PLR, LMR, hemogram parameters and PNI were analyzed using statistical methods.The PNI cut-off value for nutritional assessment in patients hospitalized in the intensive care unit due to COPD was determined as 38.5 (area under curve = 0.891, sensitivity 80.8%, specificity 88.1%, positive predictive value 92.9%, negative predictive value 88%). High-risk group according to PNI compared to low-risk group, lymphocyte count (P < .001), basophil count (P = .004), red blood cell (P < .001), hemoglobin (P < .001), hematocrit (P < .001), and LMR (P = .001) were statistically significantly lower, while NLR (P < .001) and PLR (P = .001) were statistically significantly higher. Cut-off values for lymphocyte count, basophil count, NLR, PLR, and LMR were found to be 1.18, 0.035, 7.97, 291.10, and 2.606, respectively.Nutritional risk assessment can be made in a practical way by using PNI in patients hospitalized in intensive care unit due to COPD. For this, the PNI cut-off value was determined as 38.5 in our study. In addition, NLR, PLR, LMR, basophil and lymphocyte values, which can be calculated using complete blood count parameters, may also be useful in the evaluation of nutritional status in these patients. In our study, the cut-off values determined for NLR, PLR, LMR, basophil and lymphocyte were 7.97, 291.10 and 2.606, 0.035 and 1.18, respectively. We think that the results we have obtained can provide preliminary information for future research.
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18
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Chen ZY, Lin YM, Wu JH, Zhang XQ, Zhang Y, Xie WX, Chu SQ, Li Y. Effect of doxofylline on pulmonary inflammatory response and oxidative stress during mechanical ventilation in rats with COPD. BMC Pulm Med 2022; 22:66. [PMID: 35177065 PMCID: PMC8851859 DOI: 10.1186/s12890-022-01859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/01/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the effects of doxofylline on inflammatory responses and oxidative stress during mechanical ventilation in rats with chronic obstructive pulmonary disease (COPD). METHODS Eight-week-old male Sprague Dawley rats were selected, and the COPD rat model was constructed. The rats were randomly divided into a model group (group M), a model + normal saline group (group N), a doxofylline group (group D), and a control group fed with conventional chow and given normal oxygen supply (group C) (n = 12 in each group). Tracheal intubation and mechanical ventilation were conducted in the rats in each group after anesthesia. A real-time intravenous infusion with 50 mg/kg of doxofylline was conducted in group D, and there was no drug intervention in groups C, N and M. Pathological manifestations of the pulmonary tissues were observed and compared among the groups. And some indicators were evaluated. RESULTS (1) The pulmonary tissues of the rats in groups M, N, and D exhibited typical pathological histological changes of COPD. (2) Groups M, N, and D showed increased Ppeak, PaCO2, total white blood cell count in BALF, and IL-8, TNF-α, and MDA levels in the pulmonary tissue and BALF, and decreased PaO2 and IL-10 and SOD levels, compared with group C. (3). Group D showed decreased Ppeak, PaCO2, total white blood cell count in BALF, and IL-8, TNF-α, and MDA levels in the pulmonary tissue, and increased PaO2 and IL-10 and SOD levels, compared with group N or M. CONCLUSION Doxofylline was shown to improve ventilation and air exchange during mechanical ventilation in rats with COPD, reduce the inflammatory response and oxidative stress, and mitigate the degree of pulmonary tissue injury.
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Affiliation(s)
- Zhi-Yuan Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Yu-Mei Lin
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Jian-Hua Wu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Xiao-Qi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Yi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China
| | - Wen-Xi Xie
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China.
| | - Shu-Qiang Chu
- Department of Pathology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Yan Li
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 950 of Donghai Street, Fengze District, Quanzhou, 362000, China.
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Baldemir R, Öztürk A, Eraslan Doganay G, Cirik MO, Alagoz A. Evaluation of Nutritional Status in Hospitalized Chronic Obstructive Pulmonary Disease Patients and Can C-reactive Protein-to-Albumin Ratio Be Used in the Nutritional Risk Assessment in These Patients. Cureus 2022; 14:e21833. [PMID: 35291523 PMCID: PMC8895676 DOI: 10.7759/cureus.21833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
Background Malnutrition is common in patients diagnosed with chronic obstructive pulmonary disease (COPD). CRP/albumin ratio (CAR) can be used as a parameter to evaluate the inflammatory process and nutritional status together. The aim of this study was to make a general evaluation of the nutritional status of hospitalized patients with COPD and to investigate whether CAR can predict nutritional status in these patients. Methods Patients who were hospitalized with COPD who were consulted to the nutrition department were included in the study. The patients' Nutritional Risk Score-2002 (NRS), demographic data, diagnoses, body mass indexes (BMI), nutritional support applied to the patients were recorded. CRP, Albumin, and CAR values of the patients were determined. Patients recommended nutritional follow-up, total parenteral nutrition (TPN) or enteral nutrition (EN) initiated, and oral nutritional supplement (ONS) support were identified. Results A total of 393 patients with COPD were analyzed. 88.55% of the patients were in the NRS ≥ 3 risk group. TPN treatment was started in 10.2% of the patients, EN in 10.9%, ONS in 76.3%, and nutritional follow-up was recommended in 2.5% of the patients. While albumin level was lower in patients with NRS ≥ 3, CRP and CAR were higher in patients with NRS ≥ 3 (p < 0.05). There was a negative correlation between NRS-2002 and albumin (p < 0.001). A positive correlation was observed between NRS-2002 and CRP and CAR (p < 0.001). Age and CAR were found to be effective in predicting those with NRS-2002 ≥ 3. The cut-off value for CAR was accepted as 3.26. Conclusions The need for nutritional support is high in patients hospitalized with COPD. It is important to evaluate nutritional support needs in these patients, regardless of NRS-2002 and BMI. In this respect, the clinician's observation and the decision are as valuable as the scoring that determines malnutrition. We think that the cut-off value of 3.26 determined for CAR can be used in the nutritional risk assessment in patients with COPD.
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Troianova N, Mariotti B, Micheletti V, Calzetti F, Donini M, Salvagno G, Ferrari M, Crisafulli E, Bazzoni F. Impact of Sex on Circulating Leukocytes Composition in COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 16:3539-3550. [PMID: 34992361 PMCID: PMC8715798 DOI: 10.2147/copd.s341623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease is characterized by chronic inflammatory response both at the lung site and at the systemic level. Abnormalities in circulating leukocytes have been reported to occur in COPD patients and have been often shown to correlate with the decline in lung function. COPD affects men and women at a virtually comparable rate, even though distinct sex specific symptoms, progression and therapeutic implications have been described. Nonetheless, these sex-associated differences have not been analyzed in terms of circulating leukocytes. To assess the impact of sex on the changes of circulating immune cells in COPD patients. Patients and Methods Blood samples were collected from 50 COPD patients (31 males, 19 females) and 63 age and sex-matched controls (35 males, 28 females) enrolled in this pilot study. Complete blood cell count and multi-parametric flow cytometry analysis were performed to characterize the leukocyte populations and subsets. Results Male COPD patients are distinguished from controls by a significant increase in white blood cell counts, neutrophil total and differential counts, and neutrophil-to-lymphocyte ratio. Conversely, a generalized leukocyte decrease discriminated female COPD patients from the related controls. The impact of sex is further remarked by a decrease in adaptive immune cell subpopulations in males as opposed to a consistent increase of innate immune cell types in females correlating with disease severity. Conclusion These data indicate that the definition of specific changes of circulating leukocytes to be used as reliable biomarkers of the disease severity cannot be accomplished irrespectively of sex.
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Affiliation(s)
- Natalia Troianova
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Barbara Mariotti
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Valentina Micheletti
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Federica Calzetti
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Marta Donini
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Gianluca Salvagno
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy.,Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Marcello Ferrari
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Flavia Bazzoni
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
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Hlapčić I, Dugac AV, Popović-Grle S, Markelić I, Rako I, Rogić D, Rumora L. Influence of disease severity, smoking status and therapy regimes on leukocyte subsets and their ratios in stable chronic obstructive pulmonary disease. Arch Med Sci 2022; 18:672-681. [PMID: 35591846 PMCID: PMC9103492 DOI: 10.5114/aoms.2020.100720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Blood cells are involved in systemic inflammation in chronic obstructive pulmonary disease (COPD). We aimed to assess differences in leukocyte subsets and their ratios between COPD patients and healthy individuals as well as their association with disease severity, smoking status and therapy in COPD. MATERIAL AND METHODS One hundred and nine patients in the stable phase of COPD and 95 controls participated in the study. After blood sampling, white blood cells (WBC), neutrophils (NEUTRO), monocytes (MO), lymphocytes (LY) and basophils (BA) were determined on a Sysmex XN-1000 analyser, and ratios were calculated afterwards. RESULTS White blood cells, NEUTRO, MO and BA were higher in COPD patients than in controls. Also, COPD patients had increased neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), monocyte to lymphocyte ratio (MLR), basophil to lymphocyte ratio (BLR), basophil to monocyte ratio (BMR) and monocyte/granulocyte to lymphocyte ratio (M/GLR). Smoking has an impact on leukocyte counts, with BA, BLR and BMR being higher in COPD smokers vs. ex-smokers. Patients with very severe COPD were distinguished from moderate COPD by NLR, dNLR and M/GLR. In addition, those parameters were associated with lung function and dyspnoea, and NLR and dNLR also with multicomponent COPD indices BODCAT and DOSE. Great potential of dNLR, NLR and M/GLR in identifying COPD patients was observed regarding their odds ratios (OR) of 5.07, 2.86, 2.60, respectively (p < 0.001). Common COPD therapy did not affect any of the parameters investigated. CONCLUSIONS Leukocyte subsets and their ratios could be implemented in COPD assessment, especially in evaluating disease severity and prediction.
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Affiliation(s)
- Iva Hlapčić
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Andrea Vukić Dugac
- Clinical Department for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sanja Popović-Grle
- Clinical Department for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ivona Markelić
- Clinical Department for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivana Rako
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Dunja Rogić
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Clinical Institute of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lada Rumora
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in Various Respiratory Diseases: A Retrospective Analysis. Diagnostics (Basel) 2021; 12:diagnostics12010081. [PMID: 35054248 PMCID: PMC8774859 DOI: 10.3390/diagnostics12010081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio are two extensively used inflammatory markers that have been proved very useful in evaluating inflammation in several diseases. The present article aimed to investigate if they have any value in distinguishing among various respiratory disorders. One hundred and forty-five patients with coronavirus disease 2019 (COVID-19), 219 patients with different chronic respiratory diseases (interstitial lung disease, obstructive sleep apnea(OSA)-chronic obstructive pulmonary disease (COPD) overlap syndrome, bronchiectasis) and 161 healthy individuals as a control group were included in the study. While neither NLR nor PLR had any power in differentiating between various diseases, PLR was found to be significant but poor as a diagnostic test when the control group was compared with the OSA-COPD group. NLR was found to be significant but poor as a diagnostic test when we compared the control group with all three groups (separately): the OSA-COPD group; interstitial lung disease group, and bronchiectasis group. NLR and PLR had poor power to discriminate between various respiratory diseases and cannot be used in making the differential diagnosis.
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Zhou SY, Tao L, Zhang Z, Zhang Z, An S. Mediators of neutrophil lymphocyte ratio in the relationship between ondansetron pre-treatment and the mortality of ICU patients on mechanical ventilation: causal mediation analysis from the MIMIC-IV database. Br J Clin Pharmacol 2021; 88:2747-2756. [PMID: 34964162 DOI: 10.1111/bcp.15204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS The mortality of critically ill patients undergoing mechanical ventilation (MV) is high and few strategies are available. We explored the relationship between ondansetron pre-treatment, the neutrophil:lymphocyte ratio (NLR), and platelet:lymphocyte ratio (PLR), and mortality of ventilated patients in the intensive care unit. METHODS We developed a retrospective cohort study that involved patients undergoing MV in the Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database. Causal mediation analysis was conducted to assess the relationship of ondansetron use and mortality and explore the potential causal pathway mediated by the NLR or PLR. The primary outcome was 28-day mortality. RESULTS A total of 17,927 eligible patients was obtained (5665 had taken ondansetron before MV initiation and 12,262 patients had not). The OR for 28-day mortality for ondansetron use uncorrelated with the mediator (NLR, PLR) was 0.72 (95%CI=0.64-0.81, P <0.001). Ondansetron was also associated with a reduction in 28-day mortality after controlling for the mediator of NLR (OR = 0.98, 95%CI = 0.97-0.99, P < 0.01). For the indirect effect, the NLR could explain 13.47% (95%CI = 8.59-20.54%, P < 0.01) of the impact of ondansetron use on 28-day mortality. The proportion mediated increased to 21.50% (95%CI = 12.36-47.44%, P < 0.01) for 90-day mortality. Adjusted mediation analysis revealed no suggestion of a causal mediation pathway for this effect by the PLR (P = 0.12). CONCLUSIONS NLR may play substantial roles in the relationship between ondansetron pre-treatment before initiation of mechanical ventilation and the reduction of death risk in ventilated patients.
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Affiliation(s)
- Shi Yu Zhou
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Lili Tao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zheng Zhang
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenhui Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shengli An
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
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Baldemir R, Alagoz A. The Relationship Between Mortality, Nutritional Status, and Laboratory Parameters in Geriatric Chronic Obstructive Pulmonary Disease Patients. Cureus 2021; 13:e20526. [PMID: 35070560 PMCID: PMC8767440 DOI: 10.7759/cureus.20526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In geriatric patients, limitations in physical, mental, and/or social functions occur as a result of acute and/or chronic disease along with age-related degenerative changes. This study aimed to investigate the relationship between nutritional status, mean platelet volume (MPV), C-reactive protein (CRP)-to-albumin ratio (CAR), and mortality in geriatric chronic obstructive pulmonary disease (COPD) patients. METHODS Patients aged 65 years and older who were tertiary state hospitalized with COPD were included in the study. Demographic data of the patients, diagnosis, nutritional risk score-2002 (NRS-2002) score, and body mass index (BMI) were recorded. Glucose, MPV, CRP, albumin, CAR values of the patients, as well as 30-day and 90-day mortality status after nutritional evaluation, were determined. Patients hospitalized for a reason other than COPD, those using anti-inflammatory drugs, patients with missing data, and those in intensive care units were excluded from the study. Patients were divided into two groups based on NRS-2002: NRS-2002; 1 and 2, and NRS-2002; ≥3. RESULTS Four hundred eighteen patients were hospitalized for COPD. Of these patients, 279 were aged 65 and over, but due to missing data, only 261 patients' data were analyzed. The 30-day and 90-day mortality rates were quite high in patients with a diagnosis of COPD who needed nutritional support (37.5% and 49.8%). When the demographic data and laboratory values of the patients are examined according to the 30-day and 90-day mortality status, the MPV value is statistically significantly higher in those with mortality at the end of 90 days (p < 0.05). Despite the fact that the NRS-2002 ≥3 group had higher 30-day and 90-day mortality rates than the NRS-2002 1 or 2 groups, there was no statistically significant difference between the groups (p > 0.05). CONCLUSIONS As a result, 90-day mortality was observed in approximately half of the patients, and the majority of these patients were male. Parameters that could predict 30-day and 90-day mortality could not be determined without MPV. Inflammatory parameters such as MPV can guide the determination of nutritional needs, especially in geriatric patients with COPD. Because of the high mortality rates in geriatric patients with COPD who need nutritional support, nutritional support should be started without delay in these patients. There is a need for prospective randomized controlled multicenter studies on this subject.
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Affiliation(s)
- Ramazan Baldemir
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ali Alagoz
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
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Ellingsen J, Janson C, Bröms K, Lisspers K, Ställberg B, Högman M, Malinovschi A. Neutrophil-to-lymphocyte ratio, blood eosinophils and COPD exacerbations: a cohort study. ERJ Open Res 2021; 7:00471-2021. [PMID: 34988219 PMCID: PMC8711083 DOI: 10.1183/23120541.00471-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Blood neutrophil-to-lymphocyte ratio (NLR) and blood eosinophils (B-Eos) are emerging biomarkers in COPD. This study examined whether they could predict acute exacerbations of COPD (AECOPDs), and determined their longitudinal stability. Methods In this closed cohort study, Swedish subjects with spirometry-verified COPD attended three yearly visits in a stable phase of the disease. Blood cell counts, spirometry and questionnaire-assessed AECOPD-history (worsening of COPD leading to an unscheduled visit and/or use of antibiotics and/or oral corticosteroids) were collected at each visit. Results Of 466 included subjects 57% were female. Baseline mean±sd forced expiratory volume in 1 s was 58±17% predicted. High NLR (≥3.0) was more common in subjects with previous AECOPDs than in those without (33.5% versus 20.4%, p=0.002). In two-level mixed-effects logistic regression models adjusted for confounders, NLR as a continuous variable (OR 1.20, 95% CI 1.04–1.38) and B-Eos ≥300 cells·µL−1 (OR 1.54, 95% CI 1.06–2.24) were associated with future AECOPDs. In 386 subjects with blood cell data available at all three visits, the intraclass correlation coefficient for NLR was 0.61 (95% CI 0.56–0.66) and for B-Eos 0.69 (95% CI 0.64–0.73). NLR was persistently ≥3.0 in 10.6% and B-Eos was persistently ≥300 cells·µL−1 in 15.3%. Conclusions Stable phase NLR and B-Eos were associated with future AECOPDs. NLR on its own is probably not useful to predict AECOPDs but might be included in a risk scoring index. A minority of subjects with COPD had persistently elevated stable-phase NLR or B-Eos, and the biomarkers showed fair longitudinal reliability. Neutrophil-to-lymphocyte ratio and blood eosinophils in stable-phase COPD are associated with future exacerbations and show fair longitudinal reliabilityhttps://bit.ly/3CAS1jY
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Heffernan AJ, Denny KJ. Host Diagnostic Biomarkers of Infection in the ICU: Where Are We and Where Are We Going? Curr Infect Dis Rep 2021; 23:4. [PMID: 33613126 DOI: 10.1007/s11908-021-00747-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review Early identification of infection in the critically ill patient and initiation of appropriate treatment is key to reducing morbidity and mortality. On the other hand, the indiscriminate use of antimicrobials leads to harms, many of which may be exaggerated in the critically ill population. The current method of diagnosing infection in the intensive care unit relies heavily on clinical gestalt; however, this approach is plagued by biases. Therefore, a reliable, independent biomarker holds promise in the accurate determination of infection. We discuss currently used host biomarkers used in the intensive care unit and review new and emerging approaches to biomarker discovery. Recent Findings White cell count (including total white cell count, left shift, and the neutrophil-leucocyte ratio), C-reactive protein, and procalcitonin are the most common host diagnostic biomarkers for sepsis used in current clinical practice. However, their utility in the initial diagnosis of infection, and their role in the subsequent decision to commence treatment, remains limited. Novel approaches to biomarker discovery that are currently being investigated include combination biomarkers, host 'sepsis signatures' based on differential gene expression, site-specific biomarkers, biomechanical assays, and incorporation of new and pre-existing host biomarkers into machine learning algorithms. Summary To date, no single reliable independent biomarker of infection exists. Whilst new approaches to biomarker discovery hold promise, their clinical utility may be limited if previous mistakes that have afflicted sepsis biomarker research continue to be repeated.
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Affiliation(s)
- Aaron J Heffernan
- School of Medicine, Griffith University, Gold Coast, QLD Australia
- Centre for Translational Anti-infective Pharmacodynamics, Faculty of Medicine, University of Queensland, Herston, QLD Australia
| | - Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD Australia
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Herston, QLD Australia
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Yao C, Wang L, Shi F, Chen R, Li B, Liu W, Feng M, Li S. Optimized combination of circulating biomarkers as predictors of prognosis in AECOPD patients complicated with Heart Failure. Int J Med Sci 2021; 18:1592-1599. [PMID: 33746575 PMCID: PMC7976571 DOI: 10.7150/ijms.52405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/06/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Systematic inflammation, nutritional status, and cardiovascular function have been associated with the outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with heart failure (HF). However, the value of their relevant biomarkers in predicting mortality has not been well defined yet. We aimed to investigate the prognostic value of circulating biomarkers including C-reaction protein (CRP)/albumin (ALB), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and N-terminal pro-brain natriuretic peptide (NT-proBNP) for AECOPD patients with HF. Methods: A retrospective study was carried out in the Second Clinical College of Jinan University from January 1, 2013 to January 31, 2019. A total of 146 cases of AECOPD complicated with HF were enrolled and classified into survivor group (n=94) and non-survivor group (n=52). The baseline characteristics, CRP/ALB ratio, NLR, PLR, serum levels of NT-proBNP, and other indicators were collected. The predictors for prognosis were analyzed by multivariate logistic regression, and the ability to predict 28-day mortality was evaluated by receiver operating characteristics curve (ROC) and the area under the curve (AUC). Results: The patients in non-survivors had significantly higher levels of CRP, CRP/ALB, NLR, PCT and NT-proBNP, but lower ALB levels compared to the survivors [111.7 (56.9, 186.5) VS. 43.8 (10.3, 96.1) mg/L, 4.6 (2.0, 8.0) VS. 1.4 (0.3, 3.4), 22.2 (11.1, 40.1) VS. 12.0 (6.2, 24.8), 2.6 (0.2, 10.3) VS. 0.08 (0.1, 0.5) ng/ml, 17912.5 (9344.0, 34344.5) VS. 9809.0 (4415.9, 16387.2) ng/ml, 25.8 (23.2, 30.5) VS. 30.7 (27.9, 34.1) g/L; P < 0.001, <0.001, 0.001, <0.001, <0.001, and < 0.001, respectively]. No significant difference in PLR was found between the two groups (P=0.413). The logistic analysis revealed that CRP/ALB (OR=1.303, 95%CI: 1.145-1.483, P<0.001), NT-proBNP (OR=1.041, 95%CI: 1.010-1.073, P=0.009) and NLR (OR=1.010, 95%CI: 0.999-1.022, P<0.001) are independent risk factors for predicting the 28-day mortality. The AUC of the ROC curves were 0.768, 0.767, 0.757, 0.723, 0.716, and 0.668 for CRP/ALB, PCT, CRP, NT-proBNP, ALB, and NLR, respectively. The combination of CRP/ALB, NLR and NT-proBNP as biomarkers was shown to have better accuracy for predicting prognosis (AUC=0.830, 95%CI: 0.761-0.899, P<0.001), with a higher specificity of 80.8% and specificity of 77.7% as compared with each single biomarkers. Conclusions: High levels of NLR, CRP/ALB and NT-proBNP may be clinical usefully predictors for death in AECOPD patients with HF. Combination of NLR with CRP/ALB and NT-proBNP can provide a higher accuracy for predicting 28-day mortality in these patients.
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Affiliation(s)
- Can Yao
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Lingwei Wang
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Fei Shi
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Emergency Department, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Rongchang Chen
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Binbin Li
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Emergency Department, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Wenwen Liu
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Emergency Department, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Mengjie Feng
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Sinian Li
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
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Huang Y, Jiang B, Miao X, Ma J, Wang J, Ding K, Chen X, Hu Q, Fu F, Zeng T, Hu J, Hu B, Yang D, Zhang X. The Relationship of Lymphocyte to High-Density Lipoprotein Ratio with Pulmonary Function in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:3159-3169. [PMID: 33293805 PMCID: PMC7718883 DOI: 10.2147/copd.s276372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study aimed to explore the relation between lymphocyte to high-density lipoprotein ratio (LHR) and pulmonary function of chronic obstructive pulmonary disease (COPD) patients compared with neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR). Patients and Methods In total, 154 participants (n = 77 with COPD and n = 77 without COPD) were recruited. LHR, NLR, PLR, lung function and other data were collected and compared. Pearson’s correlation test and the receiver operating characteristics curves were used to compare the utility of LHR, NLR and PLR. Besides, univariate and multivariate logistic regression analyses were conducted. Results COPD patients with poorer lung function had a lower LHR level (P < 0.001). In low LHR group, more patients underwent greater airflow limitation than the other group (P = 0.006). LHR positively correlated with forced expiratory volume in 1 second in percent of the predicted value (FEV1%) (r = 0.333, P = 0.003). At a cut-off value of 2.08, the sensitivity and specificity of LHR in predicting FEV1% < 50 were 93.2% and 55.6%, respectively, with an AUC of 0.770 (P = 0.001) better than NLR and PLR. Based on logistic regression analyses, it was proved that LHR was associated with decreased risk of FEV1 <50% predicted in COPD patients (odds ratio = 0.198, 95% CI: 0.048–0.811, P = 0.024). Conclusion In contrast with NLR and PLR, LHR has higher accuracy for predicting pulmonary function in COPD; lower LHR level is independently associated with poorer 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Qiaoming 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
| | - Tian Zeng
- 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
| | - Jingyu 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
| | - 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
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 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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Neutrophil-Lymphocyte Ratio (NLR) Reflects Myocardial Inhomogeneities in Hemodialyzed Patients. Mediators Inflamm 2020; 2020:6027405. [PMID: 32963494 PMCID: PMC7486637 DOI: 10.1155/2020/6027405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular diseases (CVDs) are a leading cause of death in chronically hemodialyzed (HD) patients. In this group, inflammation exerts significant impact on the prevalence of CVD morbidity and mortality. Spatial QRS-T angle is an independent and strong predictor of CV events, including sudden cardiac death (SCD), both in general population and HD patients. Pathogenesis of widened QRS-T angle is complicated and is not well established. Objectives The study is aimed at evaluating whether inflammation process can contribute to the wide QRS-T angle. Patients and Methods. The retrospective study was performed on 183 HD patients. The control group consisted of 38 patients. Demographic, biochemical, vectorcardiographic, and echocardiographic data were evaluated in all patients. Inflammation process was expressed as neutrophil-lymphocyte ratio (NLR), as well as C-reactive protein (CRP). Results Both NLR (3.40 vs. 1.95 (p < 0.0001)) and spatial QRS-T angle (50.76 vs. 93.56 (p < 0.001)) were higher in the examined group, compared to the control group. Similarly, CRP was higher in the examined group than in the control group (8.35 vs. 4.06 (p < 0.001), respectively). The QRS-T angle correlated with NLR, CRP, some structural echocardiographic parameters, parathormone (PTH), and calcium (Ca) concentrations. Multiple regression analysis showed that NLR is an independent QRS-T angle predictor (r = 0.498, p = 0.0027). The ROC curve analysis indicated the cut-off point of NLR equaled 4.59, where the sensitivity and specificity were the highest for predicting myocardial inhomogeneities expressed as widened QRS-T angle. Conclusion The NLR, as an inflammation marker, may indicate myocardial inhomogeneities in HD patients.
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Moon SW, Leem AY, Kim YS, Lee JH, Kim TH, Oh YM, Shin H, Chang J, Jung JY. Low serum lymphocyte level is associated with poor exercise capacity and quality of life in chronic obstructive pulmonary disease. Sci Rep 2020; 10:11700. [PMID: 32678181 PMCID: PMC7366616 DOI: 10.1038/s41598-020-68670-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate the association of serum lymphocyte level with several clinical parameters in COPD. The study population included 451 COPD patients from the Korean Obstructive Lung Disease cohort study. Serum lymphocyte level was measured every year along with various clinical parameters, such as lung function, 6-min walking (6 MW) distance, quality of life using COPD assessment test (CAT) and St. George's Respiratory Questionnaire (SGRQ) scores, exacerbations, and survival. Serum lymphocyte level less than 20% was considered as a low lymphocyte level. Normal lymphocyte and low lymphocyte groups comprised of 409 (90.7%) and 42 (9.3%) patients, respectively. Clustered analysis showed that patients in low lymphocyte group had a lower post-bronchodilator forced expiratory volume in 1 s % predicted (estimated mean = - 5.70%; P = 0.001), a lower forced vital capacity % predicted (estimated mean = - 5.63%; P = 0.005), a shorter 6 MW distance (estimated mean = - 41.31 m; P < 0.001), a higher CAT score (estimated mean = 2.62; P = 0.013), and a higher SGRQ score (estimated mean = 10.10; P < 0.001). Serum lymphocyte level was not associated with frequent acute exacerbations nor mortality. Low serum lymphocyte group showed poorer pulmonary function, lower 6 MW distance, and worse quality of life. Serum lymphocyte levels could be a simple and widely available predictive marker for variable clinical outcomes in COPD patients.
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Affiliation(s)
- Sung Woo Moon
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ji-Hyun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Seongnam, 13496, Republic of Korea
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri, 11923, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joon Chang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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31
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Gao X, Coull B, Lin X, Vokonas P, Sparrow D, Hou L, DeMeo DL, Litonjua AA, Schwartz J, Baccarelli AA. Association of Neutrophil to Lymphocyte Ratio With Pulmonary Function in a 30-Year Longitudinal Study of US Veterans. JAMA Netw Open 2020; 3:e2010350. [PMID: 32658288 PMCID: PMC7358911 DOI: 10.1001/jamanetworkopen.2020.10350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a critical public health burden. The neutrophil to lymphocyte ratio (NLR), an inflammation biomarker, has been associated with COPD morbidity and mortality; however, its associations with lung function decline and COPD development are poorly understood. OBJECTIVE To explore the associations of NLR with lung function decline and COPD risks. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study included white male veterans in the US with more than 30 years of follow-up to investigate the associations of NLR with lung function, COPD, and hypomethylation of cg05575921, the top DNA methylation marker of lung function changes in response to tobacco smoking. This study included 7466 visits from 1549 participants, each examined up to 13 times between 1982 and 2018. A subgroup of 1411 participants without COPD at baseline were selected to analyze the association of NLR with incident COPD. Data were analyzed from September 2019 to January 2020. EXPOSURES The primary exposure was NLR, which was estimated using automated whole blood cell counts based on a blood sample collected at each visit. The methylation level of cg05575921 was measured in blood DNA from a subgroup of 1228 visits. MAIN OUTCOMES AND MEASURES The outcomes of interest were lung function, measured as forced respiratory volume in the first second (FEV1) in liters, forced vital capacity (FVC) in liters, percentage of FVC exhaled in the first second (FEV1/FVC), and maximal midexpiratory flow rate (MMEF) in liters per minute and COPD status, defined as meeting the Global Initiative for Chronic Obstructive Lung Diseases stage II (or higher) criteria. Both outcomes were measured as each visit. RESULTS Among 1549 included men (mean [SD] age, 68.3 [9.3] years) with 7466 visits from 1982 to 2018, a 1-unit increase in NLR was associated with statistically significant mean (SE) decreases of 0.021 (0.004) L in FEV1, 0.016 (0.005) L in FVC, 0.290% (0.005) L in FVC, 0.290% (0.065%) in FEV1/FVC, and 3.65 (0.916) L/min MMEF. Changes in NLR up to approximately 10 years were associated with corresponding longitudinal changes in lung function. Furthermore, this increase in NLR was associated with 9% higher odds of COPD (odds ratio, 1.09 [95% CI, 1.03-1.15]) for all visits and 27% higher risk of incident COPD (odds ratio, 1.07 [95% CI, 1.07-1.51]) for participants without COPD at baseline. Additionally, a 1-unit increase in NLR was associated with a mean (SE) decrease of 0.0048 (0.0021 in cg05575921 hypomethylation, which may mediate the adverse association of NLR-related inflammation on lung function. CONCLUSIONS AND RELEVANCE These findings suggest that NLR may be a clinically relevant biomarker associated with high risk of lung function impairment and COPD alone or in combination with DNA methylation profiles.
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Affiliation(s)
- Xu Gao
- Laboratory of Environmental Precision Biosciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - David Sparrow
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea A. Baccarelli
- Laboratory of Environmental Precision Biosciences, Mailman School of Public Health, Columbia University, New York, New York
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Cazzola M, Puxeddu E, Ora J, Rogliani P. Evolving Concepts in Chronic Obstructive Pulmonary Disease Blood-Based Biomarkers. Mol Diagn Ther 2020; 23:603-614. [PMID: 31363933 DOI: 10.1007/s40291-019-00413-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In recent years, there has been a great deal of interest in the identification and validation of blood-based biomarkers for clinical use in chronic obstructive pulmonary disease (COPD). We now have panels of blood biomarkers that potentially hold great promise as they show statistically significant associations with COPD, but biomarkers for the diagnosis of COPD remain elusive. In fact, they are yet to demonstrate sufficient accuracy to be accepted in clinical use, and many are not specific to COPD but more related to inflammation (e.g. interleukin-6) or associated with other chronic diseases such as diabetes (e.g. soluble receptor for advanced glycation endproducts [sRAGE]). Although no single blood-based biomarker has demonstrated clinical utility for either the diagnosis or progression of COPD, it has been suggested that combinations of individual markers may provide important diagnostic or prognostic information; however, the interpretation of COPD biomarker results still requires thought and many questions remain unanswered.
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Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Ermanno Puxeddu
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Josuel Ora
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Ozer PA, Ogan N. Correlatıon of neutrophyle/lymphocyte ratio and pulmonary parameters with optic coherence tomography findings in stable chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2020; 14:353-363. [DOI: 10.1111/crj.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 01/25/2023]
Affiliation(s)
| | - Nalan Ogan
- Department of Chest Diseases Ufuk University Faculty of Medicine Ankara Turkey
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Nuñez A, Marras V, Harlander M, Mekov E, Esquinas C, Turel M, Lestan D, Petkov R, Yanev N, Pirina P, Negri S, Miravitlles M, Barrecheguren M. Association Between Routine Blood Biomarkers and Clinical Phenotypes and Exacerbations in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:681-690. [PMID: 32280207 PMCID: PMC7127861 DOI: 10.2147/copd.s240720] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased lung and systemic inflammation. We aimed to identify associations between easy-to-obtain blood biomarkers and the frequency and severity of exacerbations. Methods Cross-sectional, multicentre study performed in four centres in Spain, Italy, Bulgaria, and Slovenia. Blood samples were obtained for blood cell count, C-reactive protein (CRP), alpha-1 antitrypsin (AAT) and fibrinogen analysis. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and eosinophil/basophil ratio (EBR) were calculated. Firstly, patients were divided into clinical phenotypes according to the Spanish guidelines of COPD, and secondly, patients were classified into 2 groups: non-exacerbators (≤1 ambulatory exacerbation in the previous year) and exacerbators (≥2 ambulatory exacerbations or 1 hospitalisation in the previous year). A multivariate stepwise logistic regression model was performed to identify laboratory parameters associated with exacerbators. Results A total of 355 patients with a mean age 66 years (SD=8.9) were included, and 64% were male. The mean FEV1% (forced expiratory volume in the first second) was 55% (SD=20%), and the mean COPD Assessment Test (CAT) score was 15.6 (SD=7.9). One hundred ninety-six (55.2%) patients were classified in the non-exacerbator group, and 159 (44.8%) were exacerbators. Patients in the exacerbators group presented lower haemoglobin levels (p=0.019) and ERB (p= 0.023) but higher CRP levels (p=0.001). In the multivariate analysis, females, higher levels of CRP, lower FEV1% and low EBR were independently related to exacerbators. Conclusion Female sex, having a more severe impairment of lung function, higher CRP levels and a lower EBR are associated with an exacerbator phenotype in COPD.
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Affiliation(s)
- Alexa Nuñez
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Matevz Harlander
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Evgeni Mekov
- Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Matjaz Turel
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Lestan
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rosen Petkov
- Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | | | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Merriman RC, Dissanayake O, Alnjar S, Burns F, Miller RF. Incidence and significance of elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios among hospitalised HIV-positive adult patients. Int J STD AIDS 2019; 30:1329-1332. [PMID: 31726931 DOI: 10.1177/0956462419868881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is increasing interest in the peripheral blood platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) as markers of systemic inflammation. We audited records of unselected hospitalised HIV-positive adults to identify the frequency of elevated PLR and NLR, potential associations with specific diagnoses, and outcome. Of 259 patients audited, their median age was 47 years (interquartile range = 41–54); 188 (73%) were men. An elevated PLR occurred in 87 patients (33.6%); 67 (25.9%) had an elevated NLR; 200 (77%) had an elevated C-reactive protein (CRP). Elevated PLR and NLR was associated with a variety of infectious, inflammatory, and malignant conditions similar to conditions described in the general non-HIV-infected adult population. Additionally, elevated PLR and NLR occurred both in patients in receipt of antiretroviral therapy (with undetectable viral loads), as well as in those with newly-diagnosed and poorly-controlled infection. Fourteen patients with infectious and inflammatory conditions had an elevated PLR and normal CRP, with/without elevated NLR. There was no association between elevated PLR or NLR and ICU admission, p = 0.1001 and p = 0.605, respectively. Elevated NLR, but not PLR was associated with death, p = 0.0405 and p = 1.000, respectively: two-tailed Fisher’s exact test. The single site nature of the audit and relatively small number of patients limits these observations.
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Affiliation(s)
| | | | - Sara Alnjar
- HIV Services, Royal Free London NHS Foundation Trust, London, UK
| | - Fiona Burns
- HIV Services, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, UK
| | - Robert F Miller
- HIV Services, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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36
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Özbir S, Değirmentepe RB, Atalay HA, Alkan I, Çakır SS, Ötünçtemur A, Canat HL. The role of inflammatory parameters (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in patients with Peyronie's disease. Andrology 2019; 8:348-352. [PMID: 31512411 DOI: 10.1111/andr.12702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the ability of the systemic inflammatory parameters to predict the discrimination of the phases of Peyronie's disease (PD). MATERIALS AND METHODS Demographic, clinical, and laboratory data from 156 patients with PD were analyzed. A complete blood count (CBC) was obtained for every patient, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-eosinophil ratio (MER) were calculated for every men. Subsequently, patients were divided into two groups based upon the phase of the disease. RESULTS The mean age was 51.9 ± 9.6 in all study population. The mean duration between symptom onset and patient evaluation was 4.2 ± 3.2 months in acute phase group, while it was 32.7 ± 31.7 months in chronic phase group (p < 0.001). There were no significant differences between the groups according to comorbidities such as diabetes, hypertension, lipid abnormalities, ischemic heart disease, smoking, and alcohol consumption. There was a statistically significant difference in NLR and PLR between two groups (p = 0.008, p = 0.008, respectively). NLR and PLR were significantly correlated with discrimination status in univariate analysis (p = 0.003, p = 0.005, respectively). Multivariate regression analysis revealed that NLR was the only independent risk factor for discrimination of the phases of PD (p < 0.001). The ROC analysis revealed a cutoff value of 1.8 (AUC 0.712, p < 0.001; sensitivity 61.1%; specificity 75.0%) for the NLR. CONCLUSION Our study demonstrated that NLR could be helpful to differentiate the chronic phase from the acute phase in patients with PD. Therefore, NLR could be used as an objective biomarker to the management of the disease and choosing the appropriate treatment.
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Affiliation(s)
- S Özbir
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - R B Değirmentepe
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H A Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - I Alkan
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - S S Çakır
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - A Ötünçtemur
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H L Canat
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
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