The Value Of NLR,PLR And RDW In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:To explore and verify the value of grading evaluation of clinical diagnosis and treatment and its influence on prognosis and recurrence of neutrophil / lymphocyte ratio(NLR),platelet / lymphocyte ratio(PLR)and red cell distribution width(RDW)in AECOPD(acute exacerbation chronic obstructive pulmonary disease).Research methods: Electronic medical records of patients with chronic obstructive pulmonary disease(COPD)in Changle people’s Hospital of Weifang,Shandong Province were collected and divided into AECOPD group(n = 255)and SCOPD group(n = 62);A case-control study and a longitudinal cohort control study were carried out in the same period healthy control group(n = 91).The area under ROC curve was used to verify the effectiveness of NLR,PLR and RDW in diagnosing AECOPD;Survival analysis was used to explore the risk of exacerbation of COPD;Binary logistic regression analysis was used to find the independent influencing factors of COPD recurrence.The AECOPD group was divided into different subgroups according to different grading standards,and the prognosis of each subgroup was compared with NLR,PLR and RDW under different grouping conditions.The measurement data are expressed as mean plus minus standard deviation,and the counting data is represented by phase logarithm(percentage),and the data processing is carried out by Excel and spss26.0.For the continuous numerical variables conforming to normal distribution and square difference,the single factor variance analysis is used for comparison among the groups,and the bonfreroni method is used to correct the test level;The variance was uneven,and tamhane T2 test was used for comparison among groups.Results:1.NLR,PLR and RDW showed non normal distribution in each group.NLR,PLR and RDW were significantly different between AECOPD group and SCOPD group(P<0.001);There was significant difference between AECOPD group and healthy control group(P<0.001);There was no significant difference between SCOPD group and healthy control group(P>0.05).2.There was significant difference in BMI between AECOPD group and SCOPD group(P<0.05);There was significant difference between AECOPD group and healthy control group(P<0.001);There was no significant difference between SCOPD group and healthy control group(P>0.05).There was significant difference in WBC count between AECOPD group and SCOPD group(P<0.05);There was significant difference between AECOPD group and healthy control group(P<0.001);There was no significant difference between SCOPD group and healthy control group(P>0.05).There was significant difference in hemoglobin between AECOPD group and healthy control group(P<0.001);There was no significant difference between AECOPD group and SCOPD group,and between SCOPD group and healthy control group(P>0.05).There was no significant difference in erythrocyte count,hematocrit and mean corpuscular volume among AECOPD group,SCOPD group and healthy control group(P>0.05).3.There was a certain correlation between NLR and gender(r =-0.127,P = 0.02);It was not correlated with age,smoking index and RDW-SD(P > 0.05);It was positively correlated with heart rate(P < 0.001,r = 0.466);It was positively correlated with the score of venous thromboembolism(VTE)(P<0.001,r=0.331);It was positively correlated with PLR(P < 0.001,r = 0.601);It was positively correlated with ESR,C-reactive protein,procalcitonin and D-Dimer(P < 0.001,r = 0.287,r = 0.493,r = 0.414,r = 0.342);It was negatively correlated with the predicted value of FEV1%(P < 0.001,r=-0.51).4.In AECOPD group,the square root of NLR had a significant linear correlation with the square root of PLR(P < 0.0001),and the fitting linear equation was y = 3.193 *x + 6.558;There was a significant linear correlation between the square root of NLR and CRP(P < 0.0001),and the fitting linear equation was y = 0.881 * x + 0.936.5.(1)Compared with SCOPD group,there was significant difference in the incidence of recurrence without aggravation between AECOPD group and SCOPD group(P < 0.0001).(2)In binary logistic regression analysis,VTE score,age,respiratory rate and NLR were independent factors of AECOPD recurrence.The odds ratio(OR)increased by5.6% with age increasing by one year;With each increase of respiratory rate,OR increased by 20.8%;The OR increased by 4.7% for each unit of NLR;The OR of VTE score was 0.683.Fitting regression equation: z = 0.054 * age + 0.189 * respiratory rate +0.046 * NLR-0.382 * VTE score-7.457.(3)When the cut-off value of NLR was 2.289,the sensitivity,specificity and area under the curve were 77%,36.9% and 56.9%,respectively.NLR can be used to predict the recurrence of AECOPD to a certain extent.When NLR is greater than 2.289,it tends to relapse to a certain extent.6.There was significant difference in NLR or PLR between moderate group(FEV1≤ 50-60% predicted value)and severe group(FEV1 < 35% predicted value)in AECOPD subgroup(P < 0.05);There was no significant difference between the other subgroups(P > 0.05).7.NLR,PLR and RDW were not significantly different between AECOPD without infection group and AECOPD with infection group(P > 0.05).8.In this study,it was not observed that the difference of NLR value among AECOPD subgroups had an impact on the prognosis(P > 0.05).9.There was no significant difference in ECG between AECOPD group and SCOPD group(χ 2=5.4,P>0.017);There was no significant difference in ECG between SCOPD group and healthy control group(χ 2=3.16,P>0.017);There was significant difference in ECG between AECOPD group and healthy control group(χ 2 = 26.22,P < 0.001)(adjusted significance level of Bonferroni method was 0.017).Conclusion:1.The high value of NLR,PLR or RDW has a certain reference value in the diagnosis of AECOPD.2.AECOPD patients have higher risk of acute exacerbation and recurrence than SCOPD patients,which is related to NLR.There was significant difference in NLR(or PLR)between severe AECOPD group(FEV1 < 35% predicted value)and moderate severe AECOPD group(FEV1 ≤ 50-60% predicted value).3.The level of NLR(or PLR)in AECOPD patients was higher than that in COPD stable and healthy people,no matter whether they were infected or not;However,there was no significant difference in NLR(or PLR)between the two states.Therefore,it is still necessary to identify which factors cause the difference is not obvious,so as to choose the correct treatment in clinic.4.The difference of NLR did not significantly affect the constituent ratio of COPD recurrence and rehospitalization among AECOPD subgroups,but NLR can still be used to evaluate the clinical condition and predict the recurrence risk of AECOPD to a certain extent.In summary,NLR combined with PLR and RDW has a certain reference value for AECOPD diagnosis and treatment classification and disease assessment.Although this study did not find that different NLR levels have an impact on the prognosis,there are many interference factors,such as the existence of individual heterogeneity or the use of different drugs in the treatment,such as eliminating interference,whether there is an impact remains to be discussed.