The association of delta neutrophil index with the prognosis of acute exacerbation of chronic obstructive pulmonary disease

Sunmin Park,Myoung Kyu Lee,Seok Jeong Lee,Jihye Kim,Woo Cheol Kwon,Beomsu Shin,Sang Jun Lee,Sang-Ha Kim

doi:10.1186/s12890-020-1083-4

Sunmin Park, Myoung Kyu Lee + Show 6 more

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https://doi.org/10.1186/s12890-020-1083-4

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Abstract

BackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) is associated with infective triggers including bacterial or viral in many cases, and pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. Increased delta neutrophil index (DNI) can be useful in the detection of COPD patients with pneumonia.MethodsA retrospective cohort study was performed to investigate the mortality rate of the patients who were re-admitted within 6 months after discharge from the hospital due to AECOPD with or without CAP. We analyzed the difference of cumulative survival rate according to serum DNI level and readmission duration.ResultsFinally, 140 AECOPD patients with community-acquired pneumonia (CAP) and 174 AECOPD patients without CAP were enrolled during 6 months, respectively. The mean age was 72.2 ± 9.4 year-old, and 240 patients (76.4%) were male. When comparing the cumulative survival rate according to readmission duration (≤ 30 vs > 30 days) and DNI level (< 3.5 vs ≥ 3.5%), AECOPD patients with readmission ≤30 days and DNI ≥ 3.5% showed the lowest cumulative survival rate compared to other groups (P < 0.001). Multivariate analysis revealed readmission duration ≤30 days (HR 7.879, 95% CI 4.554–13.632, P < 0.001); and serum DNI level (HR 1.086, 95% CI 1.043–1.131, P < 0.001) were significantly associated with the mortality of AECOPD patients during 6 months. The area under the curve for readmission (≤ 30 days) + DNI level (≥ 3.5%) was 0.753 (95% CI 0.676–0.830, P < 0.001) with a sensitivity of 73.7% and a specificity of 67.3%.ConclusionAECOPD patients who were readmitted ≤30 days and DNI ≥ 3.5% showed higher mortality. DNI level can be used as a predictor of prognosis in AECOPD patients who were readmitted after discharge.

Highlights

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is associated with infective triggers including bacterial or viral in many cases, and pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes
Total subjects During study period, 827 severe AECOPD patients were admitted to a respiratory center, and 726 patients were eligible for inclusion criteria
140 AECOPD patients with Community-acquired pneumonia (CAP) (19 patients who were readmitted within 30 days and 121 patients who were readmitted after 30 days) and 174 AECOPD patients without CAP (22 patients who were readmitted within 30 days and 152 patients who were readmitted after 30 days) were enrolled during 6 months, respectively (Fig. 1)

Summary

Introduction

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is associated with infective triggers including bacterial or viral in many cases, and pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major health issues in COPD patients, and are important causes of hospital admission and mortality [1,2,3]. Several studies have identified that old age, disease severity, and use of inhaled corticosteroids are predisposing factors better inducing CAP in COPD patients [10, 12]. There is another problem that readmission of AECOPD patients discharged after inpatient treatment. Some studies explained that about 20% were readmitted due to AECOPD within 30 days after discharge [13, 14]

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