Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
School of Medicine, Tzu-Chi University, Hualien, Taiwan.
Respirology. 2023 Dec;28(12):1136-1146. doi: 10.1111/resp.14589. Epub 2023 Sep 1.
This study evaluated the predictive roles of hematologic inflammatory biomarkers including neutrophil-percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR) for mortality in community-dwelling individuals with chronic obstructive pulmonary disease (COPD).
This longitudinal study extracted data of adults 40-79 years who had physician-diagnosed COPD from the United States (US) National Health and Nutrition Examination Survey (NHANES) 1999-2018. Cox regressions determined the associations between NPAR, NLR, ELR and their components, with all-cause mortality, cardiovascular disease (CVD) mortality and mortality from chronic lower respiratory disease (CLRD). Receiver operating characteristic (ROC) curve analysis estimated the predictive performances of these biomarkers for 5-year all-cause mortality.
Data of 1158 subjects were analysed. After adjustment, higher NPAR was significantly associated with increased all-cause and CVD mortality, and mortality from CLRD (adjusted hazard ratio [aHR] = 1.14, 1.15 and 1.16). Higher NLR was associated with an increased all-cause and CVD mortality (aHR = 1.16 and 1.29). Higher neutrophil was associated with increased all-cause mortality and mortality from CLRD (aHR = 1.13 and 1.34). Albumin was associated with decreased all-cause and CVD mortality (aHR = 0.91 and 0.86). ELR, eosinophil or lymphocyte was not significantly associated with either mortality outcomes. Adjusted AUC of NPAR and NLR in predicting 5-year all-cause mortality were 0.808 (95% CI: 0.722-0.845) and 0.799 (95% CI: 0.763-0.835), respectively.
In community-dwelling US adults with COPD, increased NPAR and NLR are associated with mortality risks. NPAR outperforms the other hematologic inflammatory biomarkers in predicting 5-year all-cause mortality.
本研究评估了包括中性粒细胞-白蛋白比值（NPAR）、中性粒细胞-淋巴细胞比值（NLR）和嗜酸性粒细胞-淋巴细胞比值（ELR）在内的血液炎症生物标志物对社区居住的慢性阻塞性肺疾病（COPD）患者死亡率的预测作用。
本纵向研究从美国国家健康与营养调查（NHANES）1999-2018 年的数据中提取了 40-79 岁有医生诊断为 COPD 的成年人的数据。Cox 回归分析确定了 NPAR、NLR 和 ELR 及其成分与全因死亡率、心血管疾病（CVD）死亡率和慢性下呼吸道疾病（CLRD）死亡率之间的关系。受试者工作特征（ROC）曲线分析估计了这些生物标志物对 5 年全因死亡率的预测性能。
共分析了 1158 例患者的数据。调整后，较高的 NPAR 与全因和 CVD 死亡率以及 CLRD 死亡率增加显著相关（调整后的危险比[aHR]=1.14、1.15 和 1.16）。较高的 NLR 与全因和 CVD 死亡率增加相关（aHR=1.16 和 1.29）。较高的中性粒细胞与全因死亡率和 CLRD 死亡率增加相关（aHR=1.13 和 1.34）。白蛋白与全因和 CVD 死亡率降低相关（aHR=0.91 和 0.86）。ELR、嗜酸性粒细胞或淋巴细胞与任何死亡率结局均无显著相关性。NPAR 和 NLR 预测 5 年全因死亡率的调整后 AUC 分别为 0.808（95%CI：0.722-0.845）和 0.799（95%CI：0.763-0.835）。
在社区居住的美国 COPD 成年人中，NPAR 和 NLR 的增加与死亡率风险相关。NPAR 在预测 5 年全因死亡率方面优于其他血液炎症生物标志物。
