Association of the Neutrophil-to-Lymphocyte Ratio with Lung Function and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

• Published in: PloS one Vol. 11; no. 6; p. e0156511
• Main Authors: Lee, Heock, Um, Soo-Jung, Kim, Yun Seong, Kim, Deog Kyeom, Jang, An Soo, Choi, Hye Sook, Kim, Yee Hyung, Kim, Tae Eun, Yoo, Kwang Ha, Jung, Ki-Suck
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.06.2016; Public Library of Science (PLoS)
• Subjects: Air flow; Airflow; Airway management; Analysis; Biology and Life Sciences; Biomarkers; Blood tests; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Corticosteroids; Development and progression; Dyspnea; Female; Hospitals; Humans; Inflammation; Internal medicine; Lung - physiology; Lymphocytes; Lymphocytes - cytology; Lymphocytes - physiology; Male; Medicine; Medicine and Health Sciences; Mortality; Neutrophils; Neutrophils - cytology; Neutrophils - physiology; Prognosis; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - pathology; Pulmonary Disease, Chronic Obstructive - physiopathology; Sepsis; Singers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156511

The ratio of neutrophils to lymphocytes (NLR) is a widely available marker of inflammation. Several types of inflammatory cells and mediators have been found to be involved in the progression of chronic obstructive pulmonary disease (COPD). We sought to evaluate the association of the NLR with severity of airflow limitation and disease exacerbations in a COPD population. We analyzed 885 patients from the Korean COPD Subtype Study cohort that recruited subjects with COPD from 44 referral hospitals. We determined the relationship of NLR levels to severity of lung function using a linear regression model. In addition, we analyzed the experiences of COPD exacerbation according to the NLR quartiles. NLR levels were inversely associated with severity of airflow limitation as measured by FEV1% predicted and absolute values after adjustments for age, gender, body mass index, pack-years of smoking, and the use of inhaled corticosteroid (P<0.001, respectively). In the multivariate binary regression model, the NLR 4th quartile (vs. 1st quartile) was found to be a significant predictor of exacerbations during 1-year follow-up (OR = 2.05, 95% CI = 1.03 to 4.06, P = 0.041). Adding an NLR to FEV1 significantly improved prediction for exacerbations during 1-year follow-up as measured by the net reclassification improvement (NRI = 7.8%, P = 0.032) and the integrated discrimination improvement (IDI = 0.014, P = 0.021). The NLR showed a significant inverse relationship to airflow limitation and was a prognostic marker for future exacerbations in patients with COPD.