A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Angelo Zinellu, Elisabetta Zinellu, Maria Carmina Pau, Ciriaco Carru, Pietro Pirina, Alessandro G. Fois, Arduino A. Mangoni

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Abstract

The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respec-tively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, p = 0.005; low certainty of evidence; stand-ard mean difference = 0.82, 95% CI 0.57 to 1.06, p < 0.001; high certainty of evidence). Pooled sensi-tivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this bi-omarker for early risk stratification and management in this group.

Original languageEnglish
Article number3365
Number of pages21
JournalJournal of Clinical Medicine
Volume11
Issue number12
DOIs
Publication statusPublished - 2 Jun 2022

Keywords

  • acute exacerbation of chronic obstructive pulmonary disease
  • adverse outcomes
  • biomarker
  • inflammation
  • mortality
  • neutrophil-to-lymphocyte ratio
  • prognostic capacity

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