Cojocaru Elena, Haliga Raluca Ecaterina, Ene Gianina-Valentina Băcescu, Cojocaru Cristian
Morpho-Functional Sciences II Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Medical III Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
J Clin Med. 2025 Apr 27;14(9):3028. doi: 10.3390/jcm14093028.
Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of intensive care unit (ICU) admissions and in-hospital mortality. Several hematological inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), and systemic immune-inflammation index (SII), have been proposed as markers of disease severity and mortality. A retrospective study was conducted on 104 ICU patients with AECOPD over a two-year period. We collected and analyzed clinical, demographic, and laboratory data. The hematological indices of the two groups-survivors (n = 39) and non-survivors (n = 65)-were compared to assess differences. We used t-tests, ANOVA, chi-square tests, and Mann-Whitney U tests to compare the groups. The factors that independently predicted mortality were identified using multivariate logistic regression. We examined survival differences using Kaplan-Meier analysis, and ROC curves were utilized to evaluate the predictive power of each biomarker. Mortality was substantially predicted by higher SII (OR: 1.92, 95% CI: 1.24-3.08, = 0.002) and NLR (OR: 2.89, 95% CI: 1.72-4.82, < 0.001). Patients with NLR > 8.0 and SII > 1800 had significantly lower survival rates (log-rank < 0.001), according to Kaplan-Meier analysis. SII (AUC = 0.79) and NLR (AUC = 0.82) were the best predictors of death, according to ROC analysis. In ICU-admitted AECOPD patients, NLR, MLR, PLR, dNLR, and SII are independent predictors of mortality. Due to their ease of evaluation and predictive capabilities, they should be included in ICU risk models for early interventions.
慢性阻塞性肺疾病严重急性加重（AECOPD）是重症监护病房（ICU）收治和院内死亡的主要原因。包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、衍生NLR（dNLR）和全身免疫炎症指数（SII）在内的几种血液学炎症生物标志物已被提议作为疾病严重程度和死亡率的标志物。对104例AECOPD的ICU患者进行了为期两年的回顾性研究。我们收集并分析了临床、人口统计学和实验室数据。比较了两组（幸存者，n = 39；非幸存者，n = 65）的血液学指标以评估差异。我们使用t检验、方差分析、卡方检验和曼-惠特尼U检验来比较各组。使用多因素逻辑回归确定独立预测死亡率的因素。我们使用Kaplan-Meier分析检查生存差异，并利用ROC曲线评估每个生物标志物的预测能力。较高的SII（OR：1.92，95%CI：1.24 - 3.08，P = 0.002）和NLR（OR：2.89，95%CI：1.72 - 4.82，P < 0.001）可显著预测死亡率。根据Kaplan-Meier分析，NLR > 8.0且SII > 1800的患者生存率显著较低（对数秩检验P < 0.001）。根据ROC分析，SII（AUC = 0.79）和NLR（AUC = 0.82）是死亡的最佳预测指标。在入住ICU的AECOPD患者中，NLR、MLR、PLR、dNLR和SII是死亡率的独立预测指标。由于它们易于评估且具有预测能力，应将它们纳入ICU风险模型以进行早期干预。
