Association of Neutrophil-to-Lymphocyte Ratio with Etiology and Severity of Acute Exacerbation of COPD
Mia Parvej *
Department of Medicine, North East Medical College Hospital, Sylhet, Bangladesh.
S. N. Chowdhury
Department of Pharmacology, North East Medical College Hospital, Sylhet, Bangladesh.
A. K. Chowdhury
Department of Pharmacology, North East Medical College Hospital, Sylhet, Bangladesh.
M. S. R. Rumel
Department of Medicine, North East Medical College Hospital, Sylhet, Bangladesh.
A. Sayeed
Department of Psychiatry, North East Medical College Hospital, Sylhet, Bangladesh.
I. A. Z. Chowdhury
Department of Medicine, MAG Osmani Medical College Hospital, Sylhet, Bangladesh.
F. Jannat
Diabetic Association Medical College & Hospital, Faridpur, Bangladesh.
D. Chowdhury
Department of Paediatrics, Chittagong Medical College Hospital, Chittagong, Bangladesh.
R. Jannath
Department of Paediatrics, Bangladesh Institute of Tropical & Infectious Disease, Chittagong, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) refer to an abrupt deterioration in airway function and respiratory symptoms among individuals with COPD. The neutrophil-to-lymphocyte ratio (NLR) is a simple, cost-effective biomarker of systemic inflammation. Early diagnosis and clinical assessment may be enhanced by assessing the relationship between NLR and the aetiology and severity of AECOPD.
Objective: To assess the association of the neutrophil-to-lymphocyte ratio (NLR) with the aetiology and severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
Methods: This cross-sectional observational study enrolled 180 patients with AECOPD through convenience sampling at the Department of Medicine, North East Medical College Hospital, Sylhet, over an eight-month period. Clinical information was recorded, and venous blood samples were collected for complete blood count, differential leucocyte count and C-reactive protein assessment. Patients were classified as having infectious exacerbations based on the study's specified inflammatory laboratory criteria. Associations were evaluated using the Mann–Whitney U test, receiver operating characteristic analysis and univariate logistic regression.
Results: Of 180 patients, 126 (70%) were classified as having infectious exacerbations and 54 (30%) as having non-infectious exacerbations. The overall mean NLR was 6.78 ± 4.52. Mean NLR was higher in the infectious than the non-infectious group (5.96 versus 4.59; p = 0.014). An NLR cut-off of 5.12 distinguished severe or very severe exacerbations with 70.7% sensitivity, 73.0% specificity and an area under the curve of 0.772. NLR was associated with exacerbation severity in univariate regression (OR 1.347; 95% CI 1.171–1.550).
Conclusion: NLR was associated with presumed infectious aetiology and exacerbation severity in this hospital-based cohort and may have value as an adjunct to clinical assessment.
Keywords: Acute exacerbation of chronic obstructive pulmonary disease, Neutrophil-to-lymphocyte ratio, infectious exacerbation, non-infectious exacerbation, disease severity, systemic inflammation, complete blood count, receiver operating characteristic curve, sensitivity, specificity