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Hu D, Huang J, Zhao W, Xu M, Ma Y, Gong Z, Zhang Q, Zhao H. A Low Eosinophil to Platelet Ratio as a Worse Prognostic Index for Emergency Department Attendance in Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2024; 19:139-147. [PMID: 38249823 PMCID: PMC10799650 DOI: 10.2147/copd.s442715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Purpose Identifying prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is challenging. Eosinophils and platelet are involved in the development of COPD, which may predict adverse events. The objective of this study was to determine the effect of the eosinophil to platelet ratio (EPR) in predicting adverse events in patients with AECOPD who visited the emergency department. Patients and Methods The records of patients with AECOPD treated at Dalian Municipal Friendship Hospital from January 2018 to December 2020 were retrospectively reviewed. The relationship between the clinical characteristics and EPR, as cut-off value of 0.755, was evaluated. Results A total of 508 patients with an AECOPD (316 male, 192 female) were included. An optimal AUC cutoff of 0.755 for the EPR segregated the patients into 2 groups with significantly different mortality (25.3% vs 5.5%, P < 0.001). The same mortality risk with lower EPR was observed among the patients with emergency room attendance (35.6% vs 11.1%, P < 0.001). A model including EPR <0.755, exacerbation history, PaO2 <60mmHg, PaCO2 >50 mm Hg, hypoalbuminemia and age ≥80 was developed to predict death risk and showed good performance. Conclusion During severe COPD exacerbation, an EPR < 0.755 preceding therapy can predict worse outcomes in patients with an AECOPD.
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Affiliation(s)
- Dapeng Hu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Department of Emergency Medicine, Dalian Municipal Friendship Hospital, Dalian, Liaoning, 116001, People’s Republic of China
| | - Junwen Huang
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Wenqu Zhao
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Maosheng Xu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Yanyan Ma
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Zhaoqian Gong
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Qian Zhang
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Haijin Zhao
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, NanFang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
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Dai L, Liang BM, Ou XM. Predictive value of neutrophil-to-lymphocyte ratio and bilirubin levels in the readmission of acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci 2023; 365:169-175. [PMID: 36167155 DOI: 10.1016/j.amjms.2022.05.026] [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: 09/24/2020] [Revised: 08/16/2021] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Th aim of this study was to analyze acute exacerbation of chronic obstructive pulmonary disease (AECOPD) readmission events and to determine whether neutrophil-to-lymphocyte ratio (NLR) and bilirubin levels were associated with readmission after discharge due to AECOPD. METHODS A total of 170 patients with AECOPD were included. Patients were stratified into the readmission group if patients had two or more readmissions within 2 years of the previous discharge, and the non-readmission group with one readmission or none within 2 years of the last discharge. Data were collected and compared between groups. The patients were separated by the cutoffs of NLR and bilirubin level. The number of all-cause readmissions within 2 years, time to first COPD-related readmission, 1-year/2-year COPD-related readmission, 1-year/2-year all-cause mortality were compared between groups, respectively. RESULTS Compared with the readmission group, patients of the non-readmission group had a shorter length of hospital stay, more systemic corticosteroid use, higher NLR, higher bilirubin levels, and lower eosinophils counts (p < 0.05). NLR and bilirubin levels on admission had significant association with the number of all-cause readmissions (p < 0.05). Lower bilirubin was associated with an increased risk of 1-year COPD-related readmission (OR 5.063) and 2-year COPD-related readmission (OR 4.699). CONCLUSIONS For patients with AECOPD, longer hospital stay, and less use of systemic corticosteroids may be associated with a higher risk of readmission. NLR and bilirubin levels on admission may be related to the number of all-cause readmissions. Bilirubin can be regarded as a biomarker to predict readmission rates within 2 years after discharged throughout the course of the disease.
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Affiliation(s)
- Lu Dai
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bin-Miao Liang
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Xue-Mei Ou
- Department of Respiratory and Critical Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu 610041, China
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Zinellu A, Zinellu E, Mangoni AA, Pau MC, Carru C, Pirina P, Fois AG. Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: present and future. Eur Respir Rev 2022; 31:31/166/220095. [DOI: 10.1183/16000617.0095-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalisation and death in COPD patients. In addition to the identification of better strategies to prevent AECOPD, there is an intense focus on discovering novel markers of disease severity that enhance risk stratification on hospital admission for the targeted institution of aggressiveversussupportive treatments. In the quest for such biomarkers, an increasing body of evidence suggests that specific indexes derived from routine complete blood counts,i.e.the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), can significantly predict adverse outcomes in AECOPD. This narrative review discusses the current evidence regarding the association between the NLR and the PLR on admission and several clinical end-points (need for invasive ventilation, noninvasive mechanical ventilation failure, admission to an intensive care unit, pulmonary hypertension, length of hospitalisation, and mortality) in AECOPD. Future research directions and potential clinical applications of these haematological indexes in this patient group are also discussed.
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Zinellu A, Zinellu E, Pau MC, Carru C, Pirina P, Fois AG, Mangoni AA. A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11123365. [PMID: 35743436 PMCID: PMC9225466 DOI: 10.3390/jcm11123365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respectively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, p = 0.005; low certainty of evidence; standard mean difference = 0.82, 95% CI 0.57 to 1.06, p < 0.001; high certainty of evidence). Pooled sensitivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this biomarker for early risk stratification and management in this group.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (C.C.)
| | - Elisabetta Zinellu
- Clinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, Italy; (E.Z.); (P.P.); (A.G.F.)
| | - Maria Carmina Pau
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (C.C.)
- Quality Control Unit, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Pietro Pirina
- Clinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, Italy; (E.Z.); (P.P.); (A.G.F.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Alessandro G. Fois
- Clinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, Italy; (E.Z.); (P.P.); (A.G.F.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
- Correspondence:
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What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack? Medicina (B Aires) 2022; 58:medicina58020163. [PMID: 35208487 PMCID: PMC8880362 DOI: 10.3390/medicina58020163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis.
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Guo R, Li J, Ma X, Pan L. The predictive value of neutrophil-to-lymphocyte ratio for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2021; 14:929-936. [PMID: 32938249 DOI: 10.1080/17476348.2020.1776613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION There was inconsistent results regarding the associations of neutrophil to lymphocyte ratio (NLR) with the progression and prognosis of chronic obstructive pulmonary disease (COPD). AREAS COVERED This paper assess the role of NLR on the progression and prognosis of COPD using a meta-analytic approach. PubMed, EmBase, and the Cochrane library were systematically searched. The pooled weighted mean differences and odds ratios with 95% confidence intervals were applied for continuous and categorical variables using the random-effects model. EXPECT COMMENATRY NLR was significantly high when comparing COPD patients to healthy individuals, and acute exacerbation COPD to stable COPD. Moreover, elevated NLR were significantly associated with higher risk of mortality and exacerbation.
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Affiliation(s)
- Rui Guo
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Jia Li
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Xiaorong Ma
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University , Beijing, China
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Kichloo A, Aljadah M, Vipparla N, Wani F. Optimal glucocorticoid dose and the effects on mortality, length of stay, and readmission rates in patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). J Investig Med 2019; 67:1161-1164. [PMID: 31554676 DOI: 10.1136/jim-2019-001105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
The burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is staggering on a national and global level. Yet, surprisingly, there is a profound lack of treatment standardization with glucocorticoids in the treatment of AECOPD. In this review, we bring attention to specific literature that use a cut-off of 60 mg prednisone equivalent per day when distinguishing between high-dose and low-dose glucocorticoid treatment. We hope this review encourages future research to begin incrementally lowering the cut-off dose of 60 mg to discover if mortality, length of hospital stays, and readmission rates change between high-dose and low-dose glucocorticoid treatment. The final hope would be to establish an optimal glucocorticoid dose to treat AECOPD and eliminate treatment ambiguity.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Michael Aljadah
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA.,Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Navya Vipparla
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA.,Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Farah Wani
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA.,Department of Internal Medicine, St Mary's Hospital, Saginaw, Michigan, USA
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