A Cross-sectional Study of Correlation of Neutrophil-to-lymphocyte Ratio in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in significant morbidity and mortality. As COPD progresses, patients develop more frequent and severe exacerbations. Several scores have been tested in AECOPD, but none of them is yet widely accepted or recommended to be used in practice due to a lack of data and evidence. Aim and Objectives: (1) To compare neutrophil-to-lymphocyte ratio (NLR) between stable COPD patients and patients with acute exacerbation of COPD and (2) correlation of NLR with severity of acute exacerbation of disease as per clinical, spirometric, and arterial blood gas criteria. Materials and Methods: A total of 100 patients, 50 with acute exacerbation of COPD and 50 stable patients attending the casualty and Outpatient Department of Government Medical College and Associated Group of Hospitals, Kota, were included in the study. Results: The level of NLR was raised in patients with acute exacerbation of COPD (35.28 ± 34.66) as compared to stable COPD patients (2.23 ± 0.63) (P = 0.0001). Levels of this inflammatory marker (NLR) were also positively correlated with the duration of hospitalization (8.14 ± 5.99 days) (P = 0.0010). High NLR was found to be significantly associated with the need for mechanical ventilation (nine patients) and mortality (nine patients), and significantly associated with low forced expiratory volume 1/forced-vital capacity (0.49 ± 0.07) in cases with acute exacerbation of COPD. Conclusion: NLR can be used as a marker of acute exacerbation of COPD, as it was found to be significantly elevated in acute exacerbation patients and found within normal limits in stable patients.