Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD

CaoYuan Yao, XiaoLi Liu, Ze Tang, CaoYuan Yao, XiaoLi Liu, Ze Tang

Abstract

Background and objectives: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of hospitalization and is associated with considerable mortality, for which clinicians are seeking useful and easily obtained biomarkers for prognostic evaluation. This study aimed to determine the potential role of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as prognostic makers for hospital mortality in patients with AECOPD.

Methods: We included 303 patients with AECOPD in this retrospective study. Clinical characteristics, NLR, PLR, and serum levels of C-reactive protein (CRP) and other data were collected. Relationships between NLR/PLR and CRP were evaluated by Pearson's correlation test. Receiver operating characteristics curve and the area under the curve (AUC) were used to assess the ability of NLR and PLR to predict hospital mortality in patients with AECOPD.

Results: Mean levels of NLR and PLR of all patients with AECOPD were 7.92±8.79 and 207.21±148.47, respectively. NLR levels correlated with serum CRP levels (r=0.281, P<0.05). The overall hospital mortality rate was 12.21% (37/303). Levels of NLR and PLR were signifi-cantly higher among non-survivors compared to survivors of AECOPD (both P<0.05). At a cut-off value of 6.24, the sensitivity and specificity of the NLR in predicting hospital mortality were 81.08% and 69.17%, respectively, with an AUC of 0.803. At a cut-off of 182.68, the corresponding sensitivity, specificity and AUC of PLR were 64.86%, 58.27%, and 0.639. The combination of NLR, PLR, and CRP increased the prognostic sensitivity.

Conclusion: NLR and PLR levels were increased in non-survivor patients with AECOPD, and the NLR may be simple and useful prognostic marker for hospital mortality in patients with AECOPD. More studies should be carried out to confirm our findings.

Keywords: acute exacerbation of chronic obstructive pulmonary disease; hospital mortality; neutrophil–lymphocyte ratio; platelet–lymphocyte ratio; prognosis.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Correlations of the NLR and PLR with C-reactive protein (CRP). Notes: Correlations between neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) levels in patients with acute exacerbation of chronic obstructive pulmonary disease and serum levels of C-reactive protein were assessed by Pearson’s correlation test, (A) NLR, r=0.281, P<0.001; and (B) PLR, r=0.219, P<0.001.
Figure 2
Figure 2
ROC curves of the NLR, PLR, or CRP for predicting in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease. The receiver operating characteristic (ROC) curves for single predictors had the following areas: neutrophil–lymphocyte ratio (NLR), 0.803; C-reactive protein (CRP), 0.703; and platelet–lymphocyte ratio (PLR), 0.639.
Figure 3
Figure 3
ROC curves of the NLR, PLR, and CRP combinations for predicting in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease. The receiver operating characteristic (ROC) curves for combined predictors had the following areas: NLR + PLR, 0.800; NLR + CRP, 0.785; PLR + CRP, 0.694; NLR + PLR + CRP, 0.783. Abbreviations: NLR, neutrophil–lymphocyte ratio; CRP, C-reactive protein; PLR, platelet–lymphocyte ratio.

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