The Application Value Of FAR,NLR,PLR In The Acute Exacerbation Ofchronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease(COPD)is a common and frequently occurring disease with complex heterogeneity,and has become one of the top three causes of death in the world.Due to the severe aging population and a large smoking population in China,the prevalence and mortality rate of COPD in China are much higher than in other countries.The most important reason for the large number of incidence rate,mortality and health expenditure of chronic obstructive pulmonary disease is the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).The occurrence of AECOPD accelerates the deterioration of lung function and the progression of the disease.However,currently,the diagnosis of AECOPD mainly relies on the subjective feelings of patients and the empirical judgments of doctors.Therefore,it is particularly important to explore indicators that can diagnose AECOPD early and accurately.Currently,a large number of studies suggest that inflammatory biomarkers can predict acute exacerbation of chronic obstructive pulmonary disease and evaluate the condition.Neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)are widely studied in various inflammatory diseases as markers of systemic inflammation and are easy to obtain;Fibrinogen to albumin ratio(FAR),as a marker of systemic inflammation,has been confirmed to be related to the severity,disease activity and prognosis of tumors,acute myocardial infarction,systemic lupus erythematosus,spinal arthritis and COVID-19,but the research in AECOPD is limited.This study aims to explore the diagnostic value of FAR,NLR,and PLR in AECOPD,search for simple and effective biomarkers,identify early acute exacerbation of COPD,adjust treatment plans as soon as possible,delay disease progression,and improve patient prognosisObjective:To explore the application value of fibrinogen(FIB)/ albumin(ALB)ratio(FAR),neutrophil(NEU)/lymphocyte(LYM)ratio(NLR),platelet(PLT)/ lymphocyte(LYM)ratio(PLR)in Acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods:A retrospective study was performed in my hospital from September 2021 to September 2022.The study included 123 patients of AECOPD,who hospitalized in the Department of Respiratory and CriticalVICare Medicine.And 99 patients of SCOPD who admitted to the outpatient department were enrolled in this study during the same period.The age,gende,leukocytes,neutrophils,lymphocytes,platelets,fibrinogen,albumin and CRP were recorded in all groups,and FAR,NLR and PLR were calculated.FEV1,FVC,FEV1% pred and clinical end-points of AECOPD group were collected.The general data and CRP,FAR,NLR and PLR were compared between AECOPD and SCOPD for statistical differences.According to the2021 GOLD grading standard,the AECOPD group was divided into three groups: mild-moderate group:FEV1%pred≥50%,severe group: 30%≤FEV1%pred < 50%,and extremely severe group: FEV1%pred <30%.The data of the three groups were compared for statistical differences,which consist of CRP,FAR,NLR and PLR.According to the prognosis,the diagnostic efficacy of FAR,NLR and PLR in poor prognosis of AECOPD was studied.The correlation between FAR,NLR,PLR and CRP in patients of AECOPD was analyzed,and the ROC curve was performed to evaluate the diagnostic value of them for AECOPD.Results:1.There was no significant difference in age and gender between AECOPD and SCOPD(P > 0.05).The levels of NEU,PLT,FIB,FAR,NLR,PLR and CRP in AECOPD were significantly higher than those in SCOPD group(P < 0.001).Compared with AECOPD group,LYM and ALB values in SCOPD group were statistically higher(P < 0.001).2.According to GOLD classification,patients with acute exacerbation were divided into three groups:mild-moderate group,severe group and extremely severe group,there were no statistically significant differences in age and gender among all groups(P > 0.05).Compared with the light-moderate and severe groups,the levels of FAR,NLR and PLR in the extremely severe group were significantly increased;In addition,FAR,NLR and PLR in the severe group were significantly higher than those in the light-moderate group,and the pairwise comparison among all groups showed statistical differences(P<0.001).3.The number of FAR,NLR,PLR and CRP in poor prognosis group were significantly increased,which compared with good prognosis group(P<0.05).4.The number of FAR,NLR,PLR in AECOPD group were positively correlated with CRP(r=0.566,0.627,0.422)with statistically significant(P < 0.001).5.The ROC curve shows that the area under the curve for FAR diagnosis of AECOPD is 0.868,with a sensitivity of 74.0% and a specificity of 85.9%;The area under the curve for NLR diagnosis of AECOPD is0.832,with a sensitivity of 66.7% and a specificity of 88.9%;The area under the curve for PLR diagnosis of AECOPD was 0.800,with a sensitivity of 77.2% and a specificity of 70.7%;The area under the curve for the combined diagnosis of AECOPD was 0.900,with a sensitivity of 90.2% and a specificity of 76.8%.Conclusions:1.FAR,NLR and PLR can be used to distinguish SCOPD and AECOPD.2.FAR,NLR and PLR can be used as inflammatory markers of AECOPD,and had a significant value of the evaluation of airflow limitation and prognostic in AECOPD.3.FAR,NLR and PLR have the excellent diagnostic efficacy of AECOPD,and can be used for early identification of acute exacerbation of COPD and timely intervention to improve prognosis.