Assessing the Role of Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio to Evaluate the Severity of Chronic Obstructive Pulmonary Disease in Comparison With C-Reactive Protein
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Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is a significant worldwide disease in terms of morbidity and mortality. Acute exacerbations (AECOPD) promote the development of the disease and a high level of healthcare demands. Although C-reactive protein (CRP) is a conventional measure of systemic inflammation, more affordable and accessible readily available hematological biomarkers are on the rise to help in immediate clinical evaluation.
Objective:
To consider the prognostic value of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in patients with COPD compared to CRP.
Materials and methods:
This hospital-based, cross-sectional study recruited 142 study participants (n=71 in each group): the stable COPD (n=71) and the AECOPD (n=71) group. Spirometry (GOLD staging), clinical assessment and laboratory tests such as complete blood count and CRP were carried out. ROC curve analysis was used to calculate and compare NLR and PLR across the clinical states to determine the diagnostic accuracy.
Results:
During acute exacerbation, NLR and PLR were significantly higher than when the disease was stable (NLR:13.61 ± 4.90 vs. 2.47 ± 0.66; PLR: 255.18 ± 60.65 vs. 95.21± 27.17; p < 0.001). There were also positive relationships with a significant positive correlation between PLR and CRP (r=0.811) and NLR and PLR (r=0.911). It was found that ROC analysis has an excellent diagnostic performance in the classification of severity: NLR (AUC 0.963) at 6.28 and PLR (AUC 0.970) at 175, both with 93% sensitivity and 100% specificity. In addition, non-survivors with AECOPD had considerably higher mean NLR (23.29) and PLR (391.97) than those who survived.
Conclusion:
NLR and PLR are cost-effective and universal inflammatory biomarkers that have
prognostic sensitivity equal to that of CRP. By stratifying risks and triaging patients at greater risk of adverse outcomes and death, they can be incorporated into routine clinical practice, enabling rapid risk stratification and triage, especially in resource-limited environments.