Skip to main content
Log in

Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease: A Retrospective Study

  • Published:
Inflammation Aims and scope Submit manuscript

Abstract

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease of the lung with a high mortality and morbidity rate. Some of the inflammatory markers such as C-reactive protein (CRP), leukocyte count are associated with COPD. In this study, we aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in COPD patients comparing with the other well-known inflammatory markers. We retrospectively enrolled the laboratory results of 269 COPD patients of which 178 patients at stable period and 91 patients during acute exacerbation and 50 sex- and age- matched healthy controls. We found that NLR values of the stable COPD patients were significantly higher than those of the controls (P < 0.001). During acute exacerbation of the disease there was a further increase compared to stable period (P < 0.001). NLR values were also positively correlated with serum CRP levels and red cell distribution width (RDW) and negatively correlated with mean platelet volume (MPV) in both COPD groups. In conclusion, NLR could be considered as a new inflammatory marker for assessment of inflammation in COPD patients with its quick, cheap, easily measurable property with routine complete blood count analysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

REFERENCES

  1. MacNee, W. 2012. Chronic obstructive pulmonary disease: Epidemiology, pathophysiology, and clinical evaluation. In Clinical respiratory medicine, 4th ed, ed. S.G. Spiro, G.A. Silvestri, and A. Agusti, 531–561. Philadelphia: Elsevier Saunders.

    Chapter  Google Scholar 

  2. Hogg, J.C., F. Chu, S. Utokaparch, R. Woods, W.M. Elliott, L. Buzatu, et al. 2004. The nature of small airway obstruction in chronic obstructive pulmonary disease. New England Journal of Medicine 350: 2645–2653.

    Article  CAS  PubMed  Google Scholar 

  3. Eagan, T.M., J.K. Damås, T. Ueland, M. Voll-Aanerud, T.E. Mollnes, J.A. Hardie, et al. 2010. Neutrophil gelatinase-associated lipocalin: A biomarker in COPD. Chest 138: 888–895.

    Article  PubMed  Google Scholar 

  4. Agustí, A.G., A. Noguera, J. Sauleda, E. Sala, J. Pons, and X. Busquets. 2003. Systemic effects of chronic obstructive pulmonary disease. European Respiratory Journal 21: 347–360.

    Article  PubMed  Google Scholar 

  5. Gan, W.Q., S.F. Man, A. Senthilselvan, and D.D. Sin. 2004. Association between chronic obstructive pulmonary disease and systemic inflammation: A systematic review and a meta-analysis. Thorax 59: 574–580.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Thomsen, M., T.S. Ingebrigtsen, J.L. Marott, M. Dahl, P. Lange, J. Vestbo, et al. 2013. Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA 309: 2353–2361.

    Article  CAS  PubMed  Google Scholar 

  7. Pinto-Plata, V.M., H. Müllerova, J.F. Toso, M. Feudjo-Tepie, J.B. Soriano, R.S. Vessey, et al. 2006. C-reactive protein in patients with COPD, control smokers and non-smokers. Thorax 61: 23–28.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Antonescu-Turcu, A.L., and R. Tomic. 2009. C-reactive protein and copeptin: Prognostic predictors in chronic obstructive pulmonary disease exacerbations. Current Opinion in Pulmonary Medicine 15: 120–125.

    Article  CAS  PubMed  Google Scholar 

  9. Hotchkiss, R.S., and I.E. Karl. 2003. The pathophysiology and treatment of sepsis. New England Journal of Medicine 348: 138–150.

    Article  CAS  PubMed  Google Scholar 

  10. Ahsen, A., M.S. Ulu, S. Yuksel, K. Demir, M. Uysal, M. Erdogan, et al. 2013. As a new inflammatory marker for familial Mediterranean fever: Neutrophil-to-lymphocyte ratio. Inflammation [Epub ahead of print].

  11. Núñez, J., E. Núñez, V. Bodí, J. Sanchis, G. Miñana, L. Mainar, et al. 2008. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. American Journal of Cardiology 101: 747–752.

    Article  PubMed  Google Scholar 

  12. Turkmen, K., F.M. Erdur, F. Ozcicek, A. Ozcicek, E.M. Akbas, A. Ozbicer, et al. 2013. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodialysis International 17: 391–396.

    Article  PubMed  Google Scholar 

  13. Ertaş, G., O. Sönmez, M. Turfan, S. Kul, E. Erdoğan, A. Tasal, et al. 2013. Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation. Journal of the Neurological Sciences 324: 49–52.

    Article  PubMed  Google Scholar 

  14. Celli, B.R., W. MacNee, and ATS/ERS Task Force. 2004. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. European Respiratory Journal 23: 932–946.

    Article  CAS  PubMed  Google Scholar 

  15. Anthonisen, N.R., J. Manfreda, C.P. Warren, E.S. Hershfield, G.K. Harding, and N.A. Nelson. 1987. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine 106: 196–204.

    Article  CAS  PubMed  Google Scholar 

  16. Günay, E., S.S. Ulasli, E. Kacar, B. Halici, E. Unlu, K. Tünay, et al. 2013. Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clinical Respiratory Journal [Epub ahead of print].

  17. The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2013. (Internet) Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf (Cited 2013 July 31).

  18. Stockley, R.A. 2009. Progression of chronic obstructive pulmonary disease: Impact of inflammation, comorbidities and therapeutic intervention. Current Medical Research and Opinion 25: 1235–1245.

    Article  PubMed  Google Scholar 

  19. Schols, A.M., W.A. Buurman, A.J. Staal van den Brekel, M.A. Dentener, and E.F. Wouters. 1996. Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 51: 819–824.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Nural, S., E. Günay, B. Halici, S. Celik, and M. Ünlü. 2013. Inflammatory processes and effects of continuous positive airway pressure (CPAP) in overlap syndrome. Inflammation 36: 66–74.

    Article  CAS  PubMed  Google Scholar 

  21. Donaldson, G.C., T.A. Seemungal, I.S. Patel, A. Bhowmik, T.M. Wilkinson, J.R. Hurst, et al. 2005. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 128: 1995–2004.

    Article  PubMed  Google Scholar 

  22. Ulasli, S.S., B.A. Ozyurek, E.B. Yilmaz, and G. Ulubay. 2012. Mean platelet volume as an inflammatory marker in acute exacerbation of chronic obstructive pulmonary disease. Polskie Archiwum Medycyny Wewnętrznej 122: 284–290.

    CAS  PubMed  Google Scholar 

  23. Wang, R.T., J.Y. Li, Z.G. Cao, and Y. Li. 2013. The Mean Platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease. Respirology [Epub ahead of print].

  24. Steiropoulos, P., N. Papanas, E. Nena, M. Xanthoudaki, T. Goula, M. Froudarakis, et al. 2012. Mean platelet volume and platelet distribution width in patients with chronic obstructive pulmonary disease: The role of comorbidities. Angiology [Epub ahead of print].

  25. Güngör, B., K.S. Ozcan, I. Erdinler, A. Ekmekçi, A.T. Alper, D. Osmonov, et al. 2013. Elevated levels of RDW is associated with non-valvular atrial fibrillation. Journal of Thrombosis and Thrombolysis [Epub ahead of print].

  26. Ozsu, S., Y. Abul, S. Gunaydin, A. Orem, and T. Ozlu. 2012. Prognostic value of red cell distribution width in patients with pulmonary embolism. Clinical and Applied Thrombosis/Hemostasis [Epub ahead of print].

  27. Ozsu, S., Y. Abul, A. Gulsoy, Y. Bulbul, S. Yaman, and T. Ozlu. 2012. Red cell distribution width in patients with obstructive sleep apnea syndrome. Lung 190: 319–326.

    Article  PubMed  Google Scholar 

  28. Seyhan, E.C., M.A. Ozgül, N. Tutar, I. Omür, A. Uysal, and S. Altın. 2013. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease. COPD 10: 416–424.

    Article  PubMed  Google Scholar 

  29. Sincer, I., A. Zorlu, M.B. Yilmaz, O.T. Dogan, M.R. Ege, G. Amioglu, et al. 2012. Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart and Lung 41: 238–243.

    Article  PubMed  Google Scholar 

  30. Celikbilek, M., S. Dogan, O. Ozbakır, G. Zararsız, H. Kücük, S. Gürsoy, et al. 2013. Neutrophil–lymphocyte ratio as a predictor of disease severity in ulcerative colitis. Journal of Clinical Laboratory Analysis 27: 72–76.

    Article  CAS  PubMed  Google Scholar 

  31. Okyay, G.U., S. Inal, K. Oneç, R.E. Er, O. Paşaoğlu, H. Paşaoğlu, et al. 2013. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Renal Failure 35: 29–36.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ersin Günay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Günay, E., Sarınç Ulaşlı, S., Akar, O. et al. Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease: A Retrospective Study. Inflammation 37, 374–380 (2014). https://doi.org/10.1007/s10753-013-9749-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10753-013-9749-1

KEY WORDS

Navigation