Acartürk Tunçay Eylem, Karakurt Zuhal, Aksoy Emine, Saltürk Cuneyt, Gungor Sinem, Ciftaslan Nezihe, Irmak İlim, Yavuz Dilek, Ocakli Birsen, Adıgüzel Nalan
Respiratory Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Int J Chron Obstruct Pulmon Dis. 2017 Nov 23;12:3361-3370. doi: 10.2147/COPD.S147261. eCollection 2017.
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.
呼吸困难加重、痰液量增加及痰液脓性是慢性阻塞性肺疾病（COPD）患者的主观症状。为诊断合并慢性呼吸衰竭（CRF）的COPD急性加重，并评估抗生素治疗的必要性，医生需要更客观的标准。我们旨在研究中性粒细胞与淋巴细胞比值（NLR）是否可作为合并CRF的COPD患者感染性急性加重的标志物。
本回顾性横断面研究于2014年至2015年在一家三级教学医院的重症监护门诊进行。纳入因COPD合并CRF入院且有全血细胞计数（CBC）结果的患者。从医院在线数据库获取CBC结果和C反应蛋白（CRP）水平。“改良急性加重模型（MEM）”定义如下：急性加重A，白细胞≥12,000/mm³，CRP>10mg/dL；急性加重B，白细胞≥10,000/mm³，CRP>10mg/dL；急性加重C，白细胞≥10,000/mm³，CRP>8mg/dL；急性加重D，白细胞≥10,000/mm³，CRP>5mg/dL。为每个模型定义NLR的截断值。根据“NLR急性加重模型”，患者按NLR截断值分为两组，并根据外周血嗜酸性粒细胞百分比（嗜酸性粒细胞≥2%和<2%）进一步分组，然后与MEM进行比较。
共纳入1066例COPD患者（430例女性，40.3%），平均年龄66±13岁。NLR截断值为3.54（NLR≥3.54，n=366，34%）时，对模型A（78%，69%）、模型B（63%，71%）、模型C（61%，72%）和模型D（58%，72%）显示出最高的敏感性和特异性。48例患者（4.5%）存在外周血嗜酸性粒细胞增多（PE≥2%）。在MEM中，NLR≥3.54组中PE<2%的患者比例显著更高（<0.001）。
NLR因其简单性和成本效益，是合并CRF的COPD患者急性加重标志物的一个有吸引力的选择。在合并CRF的COPD患者中，若NLR≥3.54、PE水平<2%且存在主观症状，应考虑使用抗生素治疗。
