Zinellu Angelo, Zinellu Elisabetta, Pau Maria Carmina, Carru Ciriaco, Pirina Pietro, Fois Alessandro G, Mangoni Arduino A
Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy.
Clinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, Italy.
J Clin Med. 2022 Jun 11;11(12):3365. doi: 10.3390/jcm11123365.
The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respectively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, p = 0.005; low certainty of evidence; standard mean difference = 0.82, 95% CI 0.57 to 1.06, p < 0.001; high certainty of evidence). Pooled sensitivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this biomarker for early risk stratification and management in this group.
中性粒细胞与淋巴细胞比值（NLR）可预测稳定期慢性阻塞性肺疾病（COPD）的不良预后；然而，其在慢性阻塞性肺疾病急性加重期（AECOPD）中的预后作用尚不清楚。我们通过检索PubMed、Web of Science和Scopus数据库（检索时间从建库至2022年4月），对AECOPD患者入院时的NLR与不良预后（死亡率、机械通气需求、转入重症监护病房、住院时间、肺动脉高压或其综合情况）之间的关联进行了系统评价和荟萃分析。分别使用乔安娜·布里格斯研究所批判性评价清单和推荐分级、评估、制定与评价系统评估偏倚风险和证据确定性。在15项研究（n = 10,038例患者）中，NLR与不良预后风险显著相关（比值比 = 1.054，95%置信区间1.016至1.093，p = 0.005；证据确定性低；标准均数差 = 0.82，95%置信区间0.57至1.06，p < 0.001；证据确定性高）。合并敏感度、特异度和曲线下面积分别为0.71（95%置信区间0.64至0.77）、0.73（95%置信区间0.65至0.80）和0.78（95%置信区间0.74至0.81）。在我们的研究中，入院时的NLR与AECOPD患者的不良预后显著相关，提示该生物标志物在该组患者早期风险分层和管理中具有潜在应用价值。
