Association of Neutrophil-to-Lymphocyte Ratio with Disease Severity in Patients with Chronic Obstructive Pulmonary Disease
DOI:
https://doi.org/10.31149/ijimm.v3i11.2993Keywords:
Chronic obstructive pulmonary disease, Neutrophil-to-lymphocyte ratio, Inflammation, Spirometry, Disease severityAbstract
Chronic obstructive pulmonary disease (COPD) is a condition of chronic limitation of airflow and inflammation of the lungs and other organs of the body. Neutrophil-to-lymphocyte ratio (NLR) is a simple blood test calculated from a standard complete blood count that might be related to disease burden. Elevated NLR levels have been associated with poor lung function and exacerbation risk in previous studies, but there is limited evidence from the local area. Objectives of this study to evaluate the peripheral-blood NLR in relation to the severity of COPD in adults who attended Tikrit Teaching Hospital, to assess the association of NLR with lung-function impairment, dyspnea and the previous exacerbation burden. This is an observational hospital-based study of 200 adults (160 COPD, 40 normal) aged 40–80 years, who were recruited from April 2023 to April 2024. Participants with COPD were classified into GOLD 1-4 categories according to the post-bronchodilator FEV1. Complete blood counts were done during a clinically stable period and NLR was the absolute neutrophil count/absolute lymphocyte count. Demographic data, smoking exposure, BMI, mMRC dyspnea score, exacerbation history and spirometric indices were obtained. Mean NLR increased progressively across GOLD grades, from 2.32±0.82 in GOLD 1 to 5.72±1.55 in GOLD 4, compared with 1.86±0.48 in controls (P<0.001). NLR showed an inverse correlation with FEV1% predicted (r=−0.62, P<0.001) and FEV1/FVC (r=−0.49, P<0.001), and positive correlations with mMRC score (r=0.58, P<0.001) and the number of moderate/severe exacerbations in the previous year (r=0.43, P<0.001). With severe airflow limitation (GOLD 3–4), an NLR cutoff of 3.75 gave an AUC of 0.86, sensitivity of 81.3% and specificity of 78.1%. COPD was significantly related to increased airflow limitation and clinical burden with increased NLR. NLR is readily available and inexpensive to use and can be used in combination with spirometry and symptom assessment to identify patients with more advanced disease.
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