Abstract
Background: Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammatory processes, and exacerbation of COPD represents a critical moment in the progression of COPD. Several biomarkers of inflammation have been proposed to have a predictive function in acute exacerbation. However, their use is still limited in routine clinical practice. The purpose of our study is to explore the prognostic efficacy of novel inflammatory hemogram indexes in the exacerbation among stable COPD patients.Method: A total of 275 stable COPD patients from the Shanghai COPD Investigation Comorbidity Program were analyzed in our study. Blood examinations, especially ratio indexes like platelet–lymphocyte ratio (PLR), platelet × neutrophil/lymphocyte ratio [systemic immune-inflammation index (SII)], and monocyte × neutrophil/lymphocyte ratio [systemic inflammation response index (SIRI)], lung function test, CT scans, and questionnaires were performed at baseline and routine follow-ups. Clinical characteristics and information of exacerbations were collected every 6 months. The relationship between hemogram indexes and diverse degrees of exacerbation was assessed by logistic regression. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the ability of hemogram indexes to predict exacerbation of COPD. Furthermore, the discrimination and accuracy of combined indexes were measured by ROC and calibration curve.Result: There was a significant positive correlation between PLR levels and total exacerbation of COPD patients in a stable stage in a year. Also, the predictive ability of PLR exceeded any other ratio indexes, with an AUC of 0.66. SII and SIRI ranked second only to PLR, with an AUC of 0.64. When combining PLR with other indexes (sex, COPD year, and St. George's Respiratory Questionnaire scores), they were considered as the most suitable panel of index to predict total exacerbation. Based on the result of the ROC curve and calibration curve, the combination shows optimal discrimination and accuracy to predict exacerbation events in COPD patients.Conclusion: The hemogram indexes PLR, SII, and SIRI were associated with COPD exacerbation. Moreover, the prediction capacity of exacerbation was significantly elevated after combining inflammatory hemogram index PLR with other indexes, which will make it a promisingly simple and effective marker to predict exacerbation in patients with stable COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, which is usually progressive
The patients were classified as Global Initiative for COPD (GOLD) stages 1, 2, 3, and 4
Exacerbation of COPD refers to the acute event during the clinical course of COPD [18], which is significantly associated with the clinical outcomes of patients with COPD by worsening clinical symptoms, declining lung function, and increasing mortality
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, which is usually progressive. Chronic airway and lung inflammation do exist in COPD patients [1]. In the recent few years, the exacerbation of COPD has become the focus of our attention It contributed to a series of problems [2, 3]—worsening lung function, decreasing life quality [4, 5], accelerating disease progress, and elevating the risk of hospitalization or mortality [3, 6, 7]. The use of hemogram indexes indicating systemic inflammation has been determined in clinical practice for predicting hospitalization and mortality in COPD. Several biomarkers of inflammation have been proposed to have a predictive function in acute exacerbation Their use is still limited in routine clinical practice. The purpose of our study is to explore the prognostic efficacy of novel inflammatory hemogram indexes in the exacerbation among stable COPD patients
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