Department of Infectious Disease, Fuxing Hospital, Capital Medical University, Beijing, China.
PLoS One. 2018 Sep 28;13(9):e0204377. doi: 10.1371/journal.pone.0204377. eCollection 2018.
This study aimed to determine the predictive value of the neutrophil to lymphocyte ratio (NLR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
A retrospective study was conducted from March 2012 to May 2016 in Fuxing Hospital, Capital University of Medical Science. We collected 906 cases (525 males, 381 females, mean age 81.86±9.75 years) diagnosed with AECOPD. The NLR was calculated from their white blood cell (WBC), neutrophil (NEU), and lymphocyte (LYM) counts, which were obtained at laboratory examination.
After treatment, 698 patients with AECOPD improved. The NLR was higher at admission (6.89±6.82) than after treatment (4.19±5.11) (P = 0.000). The area under the receiver operating characteristic curve (AUC) of the NLR for predicting the 28-day mortality rate was 0.737. Using 8.130 as the critical NLR value, the sensitivity was 60.5%, and the specificity was 74.8%. The AUC of the NLR for predicting the frequency of the need for invasive mechanical ventilation was 0.732. Using 10.345 as the critical NLR value, the sensitivity was 54.3%, and the specificity was 84.8%. The AUC of WBC, NEU and LYM for predicting 28-day mortality and the need for invasive mechanical ventilation in these patients were all less than 0.7. An increased NLR was an independent risk factor for 28-day mortality (OR = 1.067, 95% CI = 1.039 to 1.095, P = 0.000), intensive care unit occupancy (OR = 1.046, 95% CI = 1.023 to 1.068, P = 0.000), and the need for invasive mechanical ventilation (OR = 1.042, 95% CI = 1.019 to 1.066, P = 0.000). Compared with those patients without comorbidities, patients with renal dysfunction or upper gastrointestinal bleeding had an increased risk of death within 28 days (OR = 3.102, 95% CI = 1.525 to 6.312; OR = 4.598, 95% CI = 1.825 to 11.583, respectively), ICU admission (OR = 2.228, 95% CI = 1.286 to 3.860; OR = 3.103, 95% CI = 1.402 to 6.866, respectively), and the need for invasive mechanical ventilation (OR = 3.572, 95% CI = 1.822 to 7.000; OR = 4.279, 95% CI = 1.823 to 10.045, respectively).
In patients with AECOPD, the accuracy of the NLR for predicting the 28-day mortality rate and frequency of the need for mechanical ventilation was significantly higher than the accuracy of WBC, NEU and LYM counts. AECOPD patients with an NLR≥8.130 had higher 28-day mortality rate, while those with an NLR ≥10.345 were more likely to need invasive mechanical ventilation.
本研究旨在确定中性粒细胞与淋巴细胞比值（NLR）在慢性阻塞性肺疾病急性加重（AECOPD）患者中的预测价值。
本回顾性研究于 2012 年 3 月至 2016 年 5 月在首都医科大学附属复兴医院进行。我们收集了 906 例（525 例男性，381 例女性，平均年龄 81.86±9.75 岁）AECOPD 患者。NLR 由白细胞（WBC）、中性粒细胞（NEU）和淋巴细胞（LYM）计数计算得出，这些数据是在实验室检查中获得的。
经过治疗，698 例 AECOPD 患者病情改善。入院时 NLR （6.89±6.82）高于治疗后（4.19±5.11）（P=0.000）。NLR 预测 28 天死亡率的受试者工作特征曲线（ROC）下面积（AUC）为 0.737。以 8.130 为临界 NLR 值，灵敏度为 60.5%，特异性为 74.8%。NLR 预测需要有创机械通气的频率的 AUC 为 0.732。以 10.345 为临界 NLR 值，灵敏度为 54.3%，特异性为 84.8%。WBC、NEU 和 LYM 预测 28 天死亡率和有创机械通气的 AUC 均小于 0.7。NLR 升高是 28 天死亡率的独立危险因素（OR=1.067，95%CI=1.039 至 1.095，P=0.000）、入住重症监护病房（OR=1.046，95%CI=1.023 至 1.068，P=0.000）和需要有创机械通气（OR=1.042，95%CI=1.019 至 1.066，P=0.000）的独立危险因素。与无合并症的患者相比，有肾功能不全或上消化道出血的患者 28 天内死亡的风险增加（OR=3.102，95%CI=1.525 至 6.312；OR=4.598，95%CI=1.825 至 11.583）、入住重症监护病房（OR=2.228，95%CI=1.286 至 3.860；OR=3.103，95%CI=1.402 至 6.866）和需要有创机械通气（OR=3.572，95%CI=1.822 至 7.000；OR=4.279，95%CI=1.823 至 10.045）的风险增加。
在 AECOPD 患者中，NLR 预测 28 天死亡率和机械通气需求的准确性明显高于 WBC、NEU 和 LYM 计数。NLR≥8.130 的 AECOPD 患者 28 天死亡率较高，而 NLR≥10.345 的患者更有可能需要有创机械通气。
