Figures
- FIGURE 1
Neutrophil to lymphocyte ratio (NLR) cut-off values in chronic obstructive pulmonary disease (COPD) identified in the studies reviewed.
Tables
- TABLE 1
Studies investigating the predictive roles of neutrophil to lymphocyte ratio (NLR) in chronic obstructive pulmonary disease (COPD)
First author [ref.] Patients enrolled Study design Main findings NLR as predictor of exacerbations in stable COPD Günay [36] COPD: 178 stable, 91 exacerbations; 50 healthy controls Retrospective NLR significantly different between controls and COPD patients, but not between patients with stable COPD and with exacerbations Furutate [37] COPD: 141 stable, 49 exacerbations Retrospective NLR significantly higher in patients with exacerbations. Significant correlations with FEV1, BODE, BMI, 6MWT, mMRC, low-attenuation area and fat-free mass index Lee [38] 885 COPD, 233 exacerbations (1 year) Retrospective NLR significantly higher in patients with exacerbations. NLR predictor of exacerbations. Significant correlation with FEV1 Taylan [39] COPD: 100 stable with exacerbation; 80 healthy controls Retrospective NLR significantly higher in patients with exacerbations, NLR higher in stable COPD than in controls. NLR ≥3.29 predictor of exacerbation Farah [40] COPD: 13 stable, 72 exacerbations; 15 healthy controls Retrospective NLR significantly higher in patients with exacerbations. NLR ≥7.3 predictor of exacerbation Kurtipek [41] COPD: 94 male patients, 48 with exacerbations Prospective NLR significantly higher in exacerbations. NLR ≥3.3 predictor of exacerbation Bilir [42] COPD: 467 patients, 186 with exacerbations; 215 healthy controls Retrospective NLR significantly higher in COPD and in exacerbations. NLR ≥3.35 predictor of exacerbation In [43] COPD: 103 patients, 47 with exacerbations; 40 healthy controls Retrospective NLR significantly higher in COPD and in exacerbations. NLR ≥3.34 predictor of exacerbation NLR as marker of exacerbation aetiology (infection) Tanriverdi [44] COPD: 77 patients with exacerbations Prospective Bacterial infection in 37.4% of the patients. NLR ≥11.5 significantly associated with bacterial infection van de Geijn [45] COPD: 17 stable and 45 exacerbations (22 bacterial and 23 non-bacterial) Retrospective NLR determined with different methods significantly higher in exacerbations than in stable, and in bacterial exacerbations than in non-bacterial ones NLR in COPD patients with comorbidities Vaguliene [46] 139 lung cancer; COPD: 40 stable and 55 with lung cancer; 33 healthy controls Prospective NLR significantly higher in lung cancer patients. No significant difference in NLR between COPD and healthy patients Yasar [47] COPD: 140, 63 with metabolic syndrome; 50 healthy controls Retrospective NLR significantly higher in COPD patients than in controls, NLR significantly higher in those with metabolic syndrome. NLR ≥2.56 predictor of COPD Arisou [48] COPD: 40 stable; 40 healthy controls Prospective NLR was higher in COPD patients than in the control group. Significant positive correlation between tricuspid atrial conduction time and NLR NLR as predictor of hospitalisation Lee [49] COPD: 61 stable, 59 exacerbations; 28 healthy controls Prospective NLR significantly higher in patients with exacerbations. Significant correlations with mMRC and 6MWT. NLR ≥2.8 predictor of hospitalisation NLR as predictor of re-hospitalisation Duman [50] COPD: 1704 with exacerbations, 351 with >2% eosinophils Retrospective NLR significantly lower in the eosinophilic group. NLR predictor of re-admission and death NLR as predictor of death Rahimirad [51] COPD: 315, 70 died in hospital Retrospective NLR significantly higher in patients who died in hospital. NLR ≥4 predictor of in-hospital death Yao [52] COPD: 303 with exacerbations, 33 died in hospital Retrospective NLR significantly higher in patients who died in hospital. NLR ≥6.24 predictor of in-hospital death Xiong [53] COPD: 368 stable, 96 died during follow-up; 298 healthy controls Prospective NLR significantly higher in COPD patients than in controls. NLR significantly higher in those who died during follow-up. NLR ≥3.3 predictor of death Kumar [54] COPD: 181 with exacerbation, 16 died within 90 days Retrospective NLR significantly higher in patients who died within 90 days from exacerbation Saltürk [55] COPD in ICU: 647, 62 with >2% eosinophils Retrospective NLR significantly lower in the eosinophilic group. NLR ≥16 predictor of death NLR and oral corticosteroid therapy in COPD Sørensen [56] COPD: 386, 84 using glucocorticoids Prospective NLR significantly lower in patients without glucocorticoids, NLR predictor of death in patients not treated with glucocorticoids FEV1: forced expiratory volume in 1 s; BMI: body mass index; BODE: BMI, airflow obstruction, dyspnoea, exercise capacity; 6MWT: 6-min walking test; mMRC: modified Medical Research Council dyspnoea scale; ICU: intensive care unit.
- TABLE 2
Studies investigating relationships between neutrophil to lymphocyte ratio (NLR) and other biomarkers in chronic obstructive pulmonary disease (COPD)
First author [ref.] Main markers investigated Main findings Günay [36] CRP, PDW, RDW, MPV Increased levels of WBC, CRP, RDW and MPV in COPD. Significant positive correlation of NLR with CRP and RDW, and negative correlation with MPV in COPD Furutate [37] CRP CRP significantly increased in COPD. Significant positive correlation between NLR and CRP Taylan [39] CRP, WBC, RDW, PDW, MPV, ESR Significant correlations with CRP, WBC and ESR. High NLR values in AECOPD patients with low CRP, WBC or ESR levels Farah [40] CRP, WBC, RDW, MPV, CD64 RDW, CRP and CD64 significantly elevated in AECOPD. Significant correlations of NLR with CRP and RDW Kurtipek [41] CRP, PLR CRP and PLR are significantly higher in AECOPD. Significant positive correlation with CRP. CRP AUC was better than that of NLR, which was better than AUC for PLR Bilir [42] CRP Significant positive correlation with CRP. CRP AUC better than AUC for NLR In [43] CRP, ESR Significant positive correlation with CRP and ESR Tanriverdi [44] CRP, PCT PCT higher in infections. Significant but weak positive correlation with CRP. AUC value of PCT significantly better in predicting bacterial infection compared with the CRP or the NLR van de Geijn [45] CRP, PCT and others CRP and PCT higher in AECOPD, especially bacterial ones. Addition of PCT to CRP increased specificity for bacterial AECOPD compared to CRP alone Yasar [47] CRP, RDW, MPV, PDW CRP, RDW and PDW were higher while MPV was lower in COPD. CRP, RDW and PDW were higher and MPV was lower in patients who had metabolic syndrome Lee [49] CRP CRP was higher in exacerbations than in healthy controls Duman [50] CRP, platelet/MPV CRP was significantly higher in the non-eosinophilic group. The platelet/MPV ratio was not different between the two groups. Survival negatively influenced by elevated CRP in the non-eosinophilic group Rahimirad [51] dNLR, MLR, PLR dNLR higher in dead patients than in those discharged alive. MLR and PLR not significant in multivariate analysis Yao [52] CRP, PLR NLR levels correlated with serum CRP levels in AECOPD. CRP and PLR levels higher in dead patients than in survivors. CRP AUC higher than that of PLR in predicting death Xiong [53] ESR, EBR, CRP, RDW EBR higher in COPD than in controls, and in survivors than in dead patients. EBR and CRP are predictors of mortality, not ESR or RDW Kumar [54] PLR, urea PLR significantly associated to 90-days mortality, AUC poor Saltürk [55] CRP, platelet/MPV CRP >50 mg·mL−1 risk factor for mortality Sørensen [56] Calprotectin, YKL-40 Correlation with calprotectin. In the group not treated with systemic glucocorticoids, plasma calprotectin was significantly associated with mortality. In the group treated with systemic glucocorticoids, higher plasma YKL-40 was significantly associated with mortality CRP: C-reactive protein; PDW: platelet distribution width; RDW: red cell distribution width; MPV: mean platelet volume; WBC: white blood cell; ESR: erythrocyte sedimentation rate; PLR: platelet to lymphocyte ratio; PCT: procalcitonin; dNLR: derived neutrophil to lymphocyte ratio; MLR: monocyte to lymphocyte ratio; EBR: eosinophil to basophil ratio; AECOPD: acute exacerbation of COPD; AUC: area under the curve.
Vol 27 Issue 147
Table of Contents
Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives
