NEUTROPHIL LYMPHOCYTE RATIO IN PREDICTING OUTCOME FOR HOSPITALIZED PATIENTS WITH ACUTE EXACERBATION OF COPD

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SESSION TITLE: COPD: Reducing Exacerbations and Improving Treatment Outcomes SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of hospital admission and are associated with significant morbidity, mortality, high readmission rates and high resource utilization. Tools to predict outcomes in patients hospitalized with AECOPD would help to optimize clinical management and resource allocation. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Neutrophil to lymphocyte ratio (NLR) has been studied in various disease conditions to predict the clinical outcomes. COPD is characterized by systemic inflammation and we aimed to determine the predictive value of the NLR in patients with AECOPD METHODS: We retrospectively reviewed 424 consecutive patients with AECOPD who were admitted to our community hospital from January 2016 to December 2017. NLR was calculated from the routine CBC done at the time of admission. We divided the patients into 3 tertiles according to the NLR (1st tertile NLR 5). We analyzed the association between NLR and Length of stay (LOS), need for non-invasive ventilation (NIV), need for mechanical ventilation, ICU admission, all cause in-hospital mortality and 30 day readmission. Logistic regression was used to determine the degree of association between the NLR and each of the outcome variables. RESULTS: We found that, compared to patients in the first tertile, patients in the third tertile had a longer average LOS (7.4 vs 4.1 days, p<0.001), had more ICU admissions (32% vs 9%, p<0.003), had more patients requiring NIV (33% vs 11%, p<0.001), had more patients requiring invasive mechanical ventilation (26% vs 6%, p<0.002), higher in-hospital mortality (5% vs 2.2%, p=0.12) and higher 30 day readmission rates (21% vs 6%, p=0.2). But the all cause in-hospital mortality rate and 30 day readmission rate failed to reach statistical significance. CONCLUSIONS: NLR is being increasingly studied as a systemic inflammatory marker, particularly considering its rapid, widely available, and relatively inexpensive assessment through routine blood count analysis. The results of our retrospective analysis were consistent with the other studies that looked into NLR and outcomes in COPD exacerbations. We found that NLR at the time of admission in patients with AECOPD was a reliable biomarker to predict the length of stay, ICU admissions, use of NIV and need for invasive mechanical ventilation. More studies are needed to further validate our results. CLINICAL IMPLICATIONS: NLR is an increasingly used biomarker in inflammatory conditions. Our study shows the role of NLR in predicting the clinical outcomes in AECOPD. If these results are validated, clinicians will be able to use NLR for risk-stratifying patients with AECOPD. DISCLOSURES: No relevant relationships by Deepthi Gudivada, source=Web Response No relevant relationships by Venkat Rajasurya, source=Web Response