Peripheral Neutrophil-to-Lymphocyte Ratio in Bronchiectasis: A Marker of Disease Severity

Autores de IIS La Fe

• Miguel Ángel Martínez García

  Autor

• Raúl Méndez Ocaña

  Autor

Participantes ajenos a IIS La Fe

• Olveira C.
• Girón R.
• García-Clemente M.
• Máiz-Carro L.
• Sibila O.
• Golpe R.
• Rodríguez Hermosa J.L.
• Barreiro E.
• Prados C.
• Rodríguez López J.
• de la Rosa D.

Grupos

• Infecciones Respiratorias

• Neumología

Abstract

Most patients with bronchiectasis have a predominantly neutrophilic inflammatory profile, although other cells such as lymphocytes (as controllers of bronchial inflammation) and eosinophils also play a significant pathophysiological role. Easy-to-interpret blood biomarkers with a discriminative capacity for severity or prognosis are needed. The objective of this study was to assess whether the peripheral neutrophil-to-lymphocyte ratio (NLR) is associated with different outcomes of severity in bronchiectasis. A total of 1369 patients with bronchiectasis from the Spanish Registry of Bronchiectasis were included. To compare groups, the sample was divided into increasing quartiles of NLR ratio. Correlations between quantitative variables were established using Pearson’s P test. A simple linear regression (with the value of exacerbations as a quantitative variable) was used to determine the independent relationship between the number and severity of exacerbations and the NLR ratio. The area under the curve (AUC)-ROC was used to determine the predictive capacity of the NLR for severe bronchiectasis, according to the different multidimensional scores. Mean age: 69 (15) years (66.3% of women). The mean NLR was 2.92 (2.03). A higher NLR was associated with more severe bronchiectasis (with an especially significant discriminative power for severe forms) according to the commonly used scores (FACED, E-FACED and BSI), as well as with poorer quality of life (SGRQ), more comorbidities (Charlson index), infection by pathogenic microorganisms, and greater application of treatment. Furthermore, the NLR correlated better with severity scores than other parameters of systemic inflammation. Finally, it was an independent predictor of the incident number and severity of exacerbations. In conclusion, the NLR is an inexpensive and easy-to-measure marker of systemic inflammation for determining severity and predicting exacerbations (especially the most severe) in patients with bronchiectasis. © 2022 by the authors.

Keywords

• Aged; Biomarkers; Bronchiectasis; Female; Humans; Inflammation; Lymphocytes; Neutrophils; Quality of Life; ROC Curve; Severity of Illness Index; C reactive protein; corticosteroid; macrolide; biological marker; area under the curve; Article; body mass; bronchiectasis; Charlson Comorbidity Index; computer assisted tomography; disease exacerbation; disease severity; dyspnea; female; Haemophilus influenzae; hemoptysis; hospitalization; human; human cell; inflammation; linear regression analysis; longitudinal study; lymphocyte; lymphocyte count; major clinical study; male; mean platelet volume; microorganism; multicenter study; neutrophil; neutrophil lymphocyte ratio; observational study; outcome assessment; oxygen saturation; Pseudomonas aeruginosa; quality of life; receiver operating characteristic; retrospective study; St. George Respiratory Questionnaire; Staphylococcus aureus; aged; neutrophil; severity of illness index