Association of neutrophil-to-lymphocyte ratio and CRP with spirometry in COPD patients in North India.

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) who have high serum levels of C-reactive protein (CRP), a marker of low-grade systemic inflammation, exhibit reduced lung functions and a worse prognosis. The neutrophil-to-lymphocyte ratio (N/L ratio, NLR), obtained from a complete blood count, is an inexpensive and easily accessible inflammation marker. The NLR has proven useful in assessing the risk for patients with various cardiovascular conditions, different types of solid tumours, sepsis, and infectious diseases. Research indicates that COPD patients have significantly higher NLR values compared to healthy controls of the same age and sex, with these values increasing even more during acute COPD exacerbations compared to stable periods. Hence, identifying non-invasive and cost-effective tools to assess the severity of COPD in the PHC/CHC level would be beneficial as an early intervention.

AIM

To study the relationship between N/L ratio and CRP levels and spirometry in COPD patients.

SETTINGS AND STUDY DESIGN

Observational cross-sectional study.

METHODS AND MATERIAL

A total of 100 patients of an age > 40 years with a confirmed diagnosis of COPD according to GOLD (Global Initiative COPD patients) criteria were selected. With an informed consent, blood sample collection for N/L ratio and CRP along with spirometry was performed in all the patients.

STATISTICAL ANALYSIS USED

SPSS software with Student t-test, Chi-square t-test, ANOVA, and Spearman correlation with 95% CI is used. <0.05 is considered significant.

RESULTS

NLR was observed to be higher in the moderate grade of COPD patients. All the patients were observed with an abnormal (>5 mg/L) CRP level. FEV1, FVC%, FEV1/FVC%, N/L ratio, and CRP were significantly ( < 0.0001*) associated with severity COPD according to GOLD criteria.

CONCLUSIONS

This study concludes that the FEV1, FVC, and FEV1/FVC ratio were lower in severe COPD patients, and it also reveals that individuals with severe COPD have elevated levels of serum CRP and N/L ratio, which correlates with the severity of COPD. Elevated N/L ratio and CRP level may be used as non invasive predictors and cost-effective tools for COPD patients at the Primary health centre level for screening of the severity of COPD patients.