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Observational Study
. 2018 Sep 4:13:2721-2730.
doi: 10.2147/COPD.S170353. eCollection 2018.

Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes

Emine Aksoy  1 , Zuhal Karakurt  1 , Sinem Gungor  1 , Birsen Ocakli  1 , İpek Ozmen  1 , Elif Yildirim  1 , Eylem Tuncay  1 , Meltem Coban Agca  1 , Nezihe Ciftaslan Goksenoglu  1 , Nalan Adigüzel  1
Affiliations
Observational Study

Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes

Emine Aksoy et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes.

Method: This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate <2%), and further subdivided according to place of admission (outpatient clinic, ward, or intensive care unit [ICU]) as an indicator of disease severity. Complete blood count, biochemistry, C-reactive protein (CRP), NLR, PLR, and platelet to mean platelet volume values were recorded from an electronic hospital database system and compared among all groups.

Results: Of the 10,592 patients included in the study, 7,864 were admitted as outpatients, 2,233 to the wards, and 495 to ICU. Neutrophilic COPD patients (n=6,536, 62%) had increased inflammatory markers compared with eosinophilic COPD patients (n=4,056, 38%); median NLR was 5.11 vs 2.62 (P<0.001), PLR was 175.66 vs 130.00 (P<0.001), and CRP was 11.6 vs 7.7 (P<0.001). All values increased relative to admission to the outpatient clinic, ward, or ICU: median NLR was 3.20, 6.33, and 5.94, respectively, median PLR was 140.43, 208.46, and 207.39, respectively, and median CRP was 6.4, 15.0, and 22.8, respectively. The median NLR values of patients in outpatients/ward/ICU increased in neutrophilic and eosinophilic endotypes: 4.21/7.57/8.60 (P<0.001) and 2.50/3.43/3.42 (P=0.81), respectively. CRP showed a similar increased pattern according to severity of AECOPD endotypes.

Conclusion: In COPD exacerbation, the inflammatory markers show different increases in each COPD endotypes. These findings may be crucial for defining exacerbation endotypes, the severity of exacerbation, and treatment response during follow-up in COPD patients.

Keywords: COPD attack; hospitalization; inflammatory biomarkers; outpatients; ward and intensive care.

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Conflict of interest statement

Disclosure All the authors who have contributed to the study design do not have any industry relationships for the past 2 years. The manuscript has been read and approved by all the authors, and each author believes that the manuscript represents honest work. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of patient data. Abbreviations: CBC, complete blood count; ICU, intensive care unit.
Figure 2
Figure 2
ROC curves of inflammatory markers for mortality of hospitalized COPD acute exacerbation patients. Note: Diagonal segments are produced by ties. Abbreviations: ROC, receiver operating characteristic; PLR, platelet to lymphocyte ratio; PLT/MPV, platelet/mean platelet volume; CRP, C-reactive protein; NLR, neutrophil to lymphocyte ratio.
Figure 3
Figure 3
A treatment approach for chronic obstructive pulmonary diseases with respect to endotypes. Abbreviations: PBE, peripheral blood eosinophil; NLR, neutrophil to lymphocyte ratio.
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