Role of the neutrophil-lymphocyte relationship in the prognostic value for exacerbation and mortality among patients with Chronic Obstructive Pulmonary Disease: integrative literature review
DOI:
https://doi.org/10.33448/rsd-v10i12.20080Keywords:
Neutrophil-lymphocyte relationship; Chronic obstructive pulmonary disease; Acute exacerbation.Abstract
COPD is a disease characterized by airflow restriction, systemic inflammation and periods of acute exacerbation. Recently, the neutrophil-lymphocyte ratio (RNL) has been shown to be a sensitive predictor of acute exacerbation and the prognosis of patients with COPD. The aim of this study was to discuss the compliance between NRL in the exacerbation of COPD, presenting information that correlates the leukocyte alteration with the worsening of symptoms and the outcome of patients with COPD. Thus, an integrative literature review was carried out in the PubMed database of productions from the last 10 years. The descriptors used were: “Neutrophil to Lymphocyte Ratio”, “Chronic Obstructive Pulmonary Disease” and “Acute Exacerbation”, which were combined to delimit the search. Ten articles were selected at the end of the searches, with the years 2015, 2018 and 2020 being the most prevalent, with 20% of the publications each. The studies originated in Turkey, responsible for 40% of them, 30% of the publications were carried out in China, and Iran, Israel and Japan, each country with 10%. Higher NRL levels were found in patients who had in-hospital death (≥ 4) and hospital admission (≥ 2.7). However, some studies have shown that NRL is not useful in determining the eosinophilic phenotype of exacerbated COPD, and that inflammatory markers rise distinctly according to the endotype of exacerbation. Therefore, NRL is a simple and cost-effective parameter for prediction, monitoring and prognosis of acute exacerbation of COPD, including in stable patients, showing a positive association between acute exacerbation and cellular relationships in patients with COPD.
References
Agca, M. Ç. et al. (2017). Does eosinophilia and neutrophil to lymphocyte ratio affect hospital re-admission in cases of copd exacerbation? Tuberk Torakas, 21 (54), 282-90.
Askoy, E. et al. (2018). Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes. International Journal of COPD, 13(1), 2721-30.
Bilir, B. et al. (2016). The Predictive Role of Neutrophil to Lymphocyte ratio in Chronic Obstructive Pulmonary Disease. European Journal of General Medicine, 13 (2), 105-10.
De Sousa, L. D., Lunardi Filho, W. D., Lunardi, V. L., Santos, S. S. & Dos Santos, C. P. (2011). The nursing scientific production about the clinic: an integrative review. Rev Esc Enferm, 45(2), 494-500.
Farah, R., Ibrahim, R., Nassar, M., Najib, D., Zivony, Y. & Eshel, E. (2017). The neutrophil/lymphocyte ratio is a better addition to Creactive protein than CD64 index as a marker for infection in COPD. Panminerva Med, 59(3), 203-09.
Galvão, C. M., Sawada, N. O. & Trevizan, M. A. (2004). Systematic review: a resource that allows the incorporation of evidence into nursing practice. Rev Latino-am Enfermagem, 17(4), 758-64.
Gao, J., Wu, S. & Wu, F. (2020). Blood cell for the differentiation of airway inflammatory phenotypes in COPD exacerbations. BMC Pulmonary Medicine, 20 (1):50. 10.1186/s12890-020-1086-1.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://goldcopd.org/wpcontent/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf
Günay E. et al. (2014) Neutrophyl-yo-Lynphocyte Ratio in Chronic Obstructive Pulmonary Disease: A Retrospective Study. Inflammation, 37(2), 374-80.
Hogg, J. C. et al. (2004). The nature of small airway obstruction in chronic obstructive pulmonary disease. New England Journal of Medicine, 350 (26), 2645-53.
In, E., Kuluöztürk, M., Oner, O. & Deveci, F. (2016). The importance of Neutrophil-to-Lynphocyte Ratio in Chronic Obstructive Pulmonary Disease. Turkish Thoracic Journal, 17(2), 41-46.
Liu, X. et al. (2020). The combination of hemogram indexes to predict exacerbation in stable chronic obstructive pulmonary disease. Frontiers in Medicine, 7 (1):572435. 10.3389/fmed.2020.572435
Paliogiannis, P. et al. (2018). Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. European Respiratory Review, 27(147):170113. 10.1183/16000617.0113-2017.
Rahimirad, S., Ghaffary, M. R., Rahimirad, M. H. & Rashidi, F. (2017). Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease. Tuberk Toraks, 65 (1), 25-31.
Rufino, R. & Costa, C. (2013). Etiopatogenia da DPOC. Pulmão RJ, 22 (2), 9-14.
Sakurai, K. et al. (2018). Clinical utility of blood neutrophil lymphocyte ratio in Japanese COPD patients. BMC Pulmonary Medicine, 18 (1):65. https://doi.org/10.1186/s12890-018-0639-z.
Saltürk, C. et al. (2015). Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit? International Journal of COPD, 10 (1), 1837-46.
Taylan, M. et al. (2015). Alterations of the neutrophil–lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients. The Clinical Respiratory Journal, 11 (3), 311-17.
Tuder, R. & Petrache, I. (2012). Pathogenesis of chronic obstructive pulmonary disease. Journal of Clinical Investigation, 122(8), 2749-55.
Yao, C. Y., Liu, X. L. & Tang, Z. (2017). Prognostic role of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio for hospital mortality in patients with AECOPD. International Journal of COPD, 12(1), 2285-90.
Youself, A. & Alkhiary, W. (2016). Role of neutrophil to lymphocyte ratio in prediction of acute exacerbation of chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis, 66(1), 43-48.
Whittemore, R. & Knafl, K. (2005). The integrative review: updated methodology. J Adv Nurs, 52(5), 546-53.
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Copyright (c) 2021 Barbara Rocha Alves Araújo; Clara Alvina Davi Coelho; Júlia Oliveira Santos; Marcella Luciano de Oliveira; Rita de Cássia Medeiros Queiroz; Douglas Rocha Alves Abdalla
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