The Combination of Hemogram Indexes to Predict Exacerbation in Stable Chronic Obstructive Pulmonary Disease

Frontiers in Medicine

Zhijun Jie¹  Wenchao Gu²  Beilan Gao³  Li Yu⁴  Jian Wang⁵  Haiying Ji⁶  Jingxi Zhang⁷  Yechang Qian⁸  Hong Bao⁹  Fengying Zhang^1,10  Jingqing Hang^1,10  Xiaoyan Jin^1,11  Fengfeng Han^1,12  Xiumin Feng^1,13  Haiyan Ge^1,14  Huili Zhu^1,14  Xuanqi Liu^1,14  Shengqing Li^1,15  Min Zhou^1,16 

[1] 0Department of Respiratory Medicine, Shanghai Fifth's Hospital, Fudan University, Shanghai, China;1Department of Respiratory Medicine, Pudong New District People's Hospital, Shanghai, China;2Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China;3Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China;4Department of Respiratory Medicine, Shanghai Ninth's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;5Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China;6Department of Respiratory and Critical Care Medicine, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China;Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China;Department of Respiratory Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China;Department of Respiratory Medicine, Putuo People's Hospital, Shanghai, China;Department of Respiratory Medicine, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;Department of Respiratory and Critical Care Medicine, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China;Department of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, China;Department of Respiratory and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China;Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;

关键词: COPD;    hemogram index;    PLR;    exacerbation;    inflammation;   

DOI  :  10.3389/fmed.2020.572435

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

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