Eosinophilic and non-eosinophilic COPD patients with chronic respiratory failure: neutrophil-to-lymphocyte ratio as an exacerbation marker

• Published in: International journal of chronic obstructive pulmonary disease Vol. 12; pp. 3361 - 3370
• Main Authors: Acartürk Tunçay, Eylem, Karakurt, Zuhal, Aksoy, Emine, Saltürk, Cuneyt, Gungor, Sinem, Ciftaslan, Nezihe, Irmak, İlim, Yavuz, Dilek, Ocakli, Birsen, Adıgüzel, Nalan
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2017; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Aged; Antibiotics; Area Under Curve; Blood tests; Chronic kidney failure; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; chronic respiratory failure; Clinical Decision-Making; Cross-Sectional Studies; Disease Progression; Dosage and administration; Drug therapy; Dyspnea; Eosinophilia - blood; Eosinophilia - diagnosis; Eosinophilia - immunology; Eosinophilia - physiopathology; Eosinophils - immunology; exacerbation; Female; Hospitals; Humans; Hypoventilation; Infections; Lung - immunology; Lung - physiopathology; Lymphocyte Count; Lymphocytes; Lymphocytes - immunology; Male; Middle Aged; Neuromuscular diseases; neutrophil to lymphocyte ratio; Neutrophils; Neutrophils - immunology; Original Research; Outpatient care facilities; Patients; peripheral eosinophilia; Pneumonia; Predictive Value of Tests; Prognosis; Proteins; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - immunology; Pulmonary Disease, Chronic Obstructive - physiopathology; Respiratory failure; Respiratory Insufficiency - blood; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - immunology; Respiratory Insufficiency - physiopathology; Retrospective Studies; Risk Factors; ROC Curve; Spirometry; Steroids; Tertiary Care Centers; Thoracic surgery; Ventilators; United States > US; chronic respiratory failure; neutrophil-to-lymphocyte ratio; peripheral eosinophilia; COPD; exacerbation
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S147261

Increased dyspnea, sputum volume, and purulence are subjective symptoms in COPD patients. To diagnose COPD exacerbations with chronic respiratory failure (CRF) and to assess the requirement for antibiotic treatment, physicians require more objective criteria. We aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR) can be used as an infectious exacerbation marker in COPD patients with CRF.
This retrospective cross-sectional study was performed in the intensive care outpatient clinic of a tertiary training hospital between 2014 and 2015. Patients admitted with CRF due to COPD and who had complete blood count (CBC) results were enrolled. CBC results and C-reactive protein (CRP) levels were obtained from the hospital online database. The "modified exacerbation model (MEM)" was defined as follows: exacerbation A, leukocytes ≥12,000/mm
, CRP >10 mg/dL; exacerbation B, leukocytes ≥10,000/mm
, CRP >10 mg/dL; exacerbation C, leukocytes ≥10,000/mm
, CRP >8 mg/dL; exacerbation D, leukocytes ≥10,000/mm
, CRP >5 mg/dL. The cutoff value of NLR was defined for each model. Patients were split into two groups based on the NLR cutoff value according to the "NLR exacerbation model" and further subgrouped according to peripheral eosinophil percentage (eosinophils ≥2% and <2%) and compared with the MEM.
A total of 1,066 COPD patients (430 females, 40.3%), with a mean age of 66±13 years, were included. A NLR cutoff value of 3.54 (NLR ≥3.54, n=366, 34%) showed the highest sensitivity and specificity for model A (78%, 69%), model B (63%, 71%), model C (61%, 72%), and model D (58%, 72%). Peripheral eosinophilia (PE ≥2%) was present in 48 patients (4.5%). The ratio of patients with PE <2% in the NLR ≥3.54 group was significantly higher in the MEM (
<0.001).
The NLR presents an attractive option as an exacerbation marker in COPD patients with CRF due to its simplicity and cost-effectiveness. In COPD patients with CRF, where the NLR is ≥3.54, PE levels are <2%, and subjective symptoms are present, antibiotic treatment should be considered.