Chen Zhao, Li Wenqiang, Tang Yuanchun, Zhou Peng, He Qian, Deng Zhiping
Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China.
Department of Respiratory and Critical Care Medicine, Zigong First People's Hospital, Zigong, China.
Front Med (Lausanne). 2024 Sep 25;11:1443749. doi: 10.3389/fmed.2024.1443749. eCollection 2024.
Neutrophil-to-lymphocyte ratio (NLR) is considered a biomarker of systemic inflammation and immune activation. However, its relationship with the risk of mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between NLR and the risk of all-cause and cardiovascular mortality in patients with COPD.
Data were collected from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2018. The calculation method of NLR involves dividing the neutrophil count by the lymphocyte count in the total blood cell count. The optimal NLR threshold associated with survival outcomes was determined using the maximally selected rank statistics method (MSRSM). The relationship between NLR and the risk of all-cause mortality and cardiovascular mortality in COPD was investigated using a weighted multivariable Cox regression model. Additionally, restricted cubic spline (RCS) was employed to discuss the potential relationship between NLR patients in different groups and the risk of mortality.
In this study, 716 adults with COPD were included using the maximally selected rank statistics method, among whom 208 had higher NLR (≥2.56) and 508 had lower NLR (<2.56). During a median follow-up of 111.5 months, 162 COPD patients died from all causes, and 49 patients died from cardiovascular diseases. After adjusting for demographic, socioeconomic status, and lifestyle factors, the risk of all-cause mortality (HR = 2.07, 95%CI: 1.46-2.94) and cardiovascular mortality (HR = 3.03, 95%CI: 1.63-5.65) in patients with higher NLR was increased by 2-3 times compared to those with lower NLR. Kaplan-Meier analysis revealed significantly lower survival rates in patients with higher NLR for all-cause mortality and cardiovascular mortality ( < 0.05). Restricted cubic spline analysis showed a linear correlation between NLR and the risk of all-cause mortality and cardiovascular mortality.
NLR has a high value in independently predicting long-term all-cause and cardiovascular mortality risks in community-dwelling COPD patients. Therefore, NLR can serve as a cost-effective and widely available indicator for assessing the prognosis of COPD patients.
中性粒细胞与淋巴细胞比值（NLR）被认为是全身炎症和免疫激活的生物标志物。然而，其与慢性阻塞性肺疾病（COPD）患者死亡风险的关系仍不明确。本研究旨在探讨NLR与COPD患者全因死亡和心血管死亡风险之间的关联。
收集1999年1月至2018年12月美国国家健康与营养检查调查（NHANES）的数据。NLR的计算方法是将全血细胞计数中的中性粒细胞计数除以淋巴细胞计数。使用最大选择秩统计方法（MSRSM）确定与生存结果相关的最佳NLR阈值。采用加权多变量Cox回归模型研究NLR与COPD患者全因死亡和心血管死亡风险之间的关系。此外，使用限制立方样条（RCS）来探讨不同组NLR患者与死亡风险之间的潜在关系。
在本研究中，采用最大选择秩统计方法纳入了716例成年COPD患者，其中208例NLR较高（≥2.56），508例NLR较低（<2.56）。在中位随访111.5个月期间，162例COPD患者死于全因，49例死于心血管疾病。在调整了人口统计学、社会经济地位和生活方式因素后，NLR较高的患者全因死亡风险（HR = 2.07，95%CI：1.46 - 2.94）和心血管死亡风险（HR = 3.03，95%CI：1.63 - 5.65）比NLR较低的患者增加了2至3倍。Kaplan-Meier分析显示，NLR较高的患者全因死亡和心血管死亡的生存率显著较低（< .05）。限制立方样条分析显示NLR与全因死亡和心血管死亡风险之间存在线性相关性。
NLR在独立预测社区居住COPD患者的长期全因和心血管死亡风险方面具有很高的价值。因此，NLR可作为评估COPD患者预后的一种经济有效且广泛可用的指标。
