Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2021 Feb 17;16:341-349. doi: 10.2147/COPD.S290422. eCollection 2021.
Frequent exacerbators are a specific phenotype of chronic obstructive pulmonary disease (COPD), whose clinical characteristics and prognostic biomarkers during severe acute exacerbation (AECOPD) have not yet been fully elucidated. The aim of this study was to investigate the clinical features of severe AECOPD in frequent exacerbators and explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for outcome in this phenotype during severe exacerbation.
A total of 604 patients with severe AECOPD were retrospectively included in the study. Subjects were defined as frequent exacerbators if they experienced two or more exacerbations in the past year. Clinical characteristics and worse outcome (ICU admission, or invasive ventilation, or in-hospital mortality) during severe AECOPD were compared between frequent exacerbators and non-frequent ones. Furthermore, the relationship between NLR and worse outcome in frequent exacerbators was analyzed using logistic regression and receiver operating characteristic (ROC).
Among 604 patients with severe AECOPD, 282 (46.69%) were frequent exacerbators and 322 (53.31%) were non-frequent exacerbators. Compared with the non-frequent ones, frequent exacerbators presented higher levels of NLR (5.93 [IQR, 3.40-9.28] vs 4.41 [IQR, 2.74-6.80]; <0.001), and more worse outcome incidence (58 [20.57%] vs 38 [11.80%]; =0.003). Moreover, among the frequent exacerbators, NLR levels in the patients with worse outcome were much higher than in those without worse outcome (11.09 [IQR, 7.74-16.49] vs 5.28 [IQR, 2.93-7.93]; <0.001). Increased NLR was significantly associated with a higher risk of worse outcome in frequent exacerbators (OR, 1.43; 95% CI, 1.28-1.64; <0.001). Furthermore, ROC analysis revealed that a cut-off value of 10.23, NLR could predict worse outcome of severe AECOPD in frequent exacerbators (sensitivity 62.1%, specificity 92.0%, AUC 0.833).
Frequent exacerbators exhibited an increased level of NLR and a higher proportion of worse outcome during severe AECOPD. NLR is expected to be a promising predictive biomarker for the prognosis of severe AECOPD in frequent exacerbators.
频繁急性加重（AECOPD）患者是慢性阻塞性肺疾病（COPD）的一种特定表型，其在严重 AECOPD 期间的临床特征和预后生物标志物尚未完全阐明。本研究旨在探讨频繁 AECOPD 患者严重 AECOPD 的临床特征，并探讨中性粒细胞与淋巴细胞比值（NLR）对严重 AECOPD 中该表型预后的预测价值。
回顾性纳入 604 例严重 AECOPD 患者。如果患者在过去一年中经历两次或两次以上加重，则将其定义为频繁加重者。比较频繁加重者和非频繁加重者在严重 AECOPD 期间的临床特征和较差结局（入住 ICU、有创通气或院内死亡）。此外，使用逻辑回归和受试者工作特征（ROC）分析 NLR 与频繁加重者较差结局的关系。
在 604 例严重 AECOPD 患者中，282 例（46.69%）为频繁加重者，322 例（53.31%）为非频繁加重者。与非频繁加重者相比，频繁加重者 NLR 水平更高（5.93[IQR，3.40-9.28] vs 4.41[IQR，2.74-6.80]；<0.001），且较差结局发生率更高（58[20.57%] vs 38[11.80%]；=0.003）。此外，在频繁加重者中，预后不良者的 NLR 水平明显高于预后良好者（11.09[IQR，7.74-16.49] vs 5.28[IQR，2.93-7.93]；<0.001）。较高的 NLR 与频繁加重者较差结局的风险显著相关（OR，1.43；95%CI，1.28-1.64；<0.001）。进一步的 ROC 分析显示，NLR 的截断值为 10.23 时，可预测频繁加重者严重 AECOPD 的不良结局（灵敏度 62.1%，特异性 92.0%，AUC 0.833）。
频繁加重者在严重 AECOPD 期间表现出 NLR 水平升高和较差结局的比例更高。NLR 有望成为预测频繁加重者严重 AECOPD 预后的有前途的生物标志物。
