Serum Biomarkers in Patients with Stable and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Comparative Study

Abstract

Background: Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD.

Methods: Stable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups.

Results: HB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1.

Conclusions: Our study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.

Keywords: COPD; inflammatory biomarkers; neutrophil/lymphocyte ratio; platelet/ lymphocyte ratio.

Figure 1

A) ROC curve for using NLR (neutrophil/lymphocyte ratio) levels and AUC value (area under the curve) in the differential diagnosis of Group 1 (COPD patients with stable) and Group 2 (COPD patients with exacerbation). B) ROC curve for using PLR (platelet/lymphocyte ratio) levels and AUC value in the differential diagnosis of Group 1 and Group 2.

Figure 2

A) ROC curve for using CRP (C-reactive protein) levels and AUC value (area under the curve) in the differential diagnosis of Group 1 (COPD patients with stable) and Group 2 (COPD patients with exacerbation). B) ROC curve for using RDW (red cell distribution width) levels and AUC value in the differential diagnosis of Group 1 and Group 2.