A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission an...
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MDPI AG
2022-06-01
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| author | Angelo Zinellu Elisabetta Zinellu Maria Carmina Pau Ciriaco Carru Pietro Pirina Alessandro G. Fois Arduino A. Mangoni |
| author_facet | Angelo Zinellu Elisabetta Zinellu Maria Carmina Pau Ciriaco Carru Pietro Pirina Alessandro G. Fois Arduino A. Mangoni |
| author_sort | Angelo Zinellu |
| collection | DOAJ |
| description | The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respectively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, <i>p</i> = 0.005; low certainty of evidence; standard mean difference = 0.82, 95% CI 0.57 to 1.06, <i>p</i> < 0.001; high certainty of evidence). Pooled sensitivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this biomarker for early risk stratification and management in this group. |
| first_indexed | 2024-03-09T23:28:13Z |
| format | Article |
| id | doaj.art-5c099fd42d4b4888bbcc741ebf839ede |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:28:13Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-5c099fd42d4b4888bbcc741ebf839ede2023-11-23T17:14:47ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011112336510.3390/jcm11123365A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseAngelo Zinellu0Elisabetta Zinellu1Maria Carmina Pau2Ciriaco Carru3Pietro Pirina4Alessandro G. Fois5Arduino A. Mangoni6Department of Biomedical Sciences, University of Sassari, 07100 Sassari, ItalyClinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, ItalyDepartment of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, ItalyDepartment of Biomedical Sciences, University of Sassari, 07100 Sassari, ItalyClinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, ItalyClinical and Interventional Pneumology, University Hospital of Sassari (AOU), 07100 Sassari, ItalyDiscipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, AustraliaThe neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respectively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, <i>p</i> = 0.005; low certainty of evidence; standard mean difference = 0.82, 95% CI 0.57 to 1.06, <i>p</i> < 0.001; high certainty of evidence). Pooled sensitivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this biomarker for early risk stratification and management in this group.https://www.mdpi.com/2077-0383/11/12/3365neutrophil-to-lymphocyte ratioacute exacerbation of chronic obstructive pulmonary diseaseadverse outcomesmortalityprognostic capacitybiomarker |
| spellingShingle | Angelo Zinellu Elisabetta Zinellu Maria Carmina Pau Ciriaco Carru Pietro Pirina Alessandro G. Fois Arduino A. Mangoni A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Journal of Clinical Medicine neutrophil-to-lymphocyte ratio acute exacerbation of chronic obstructive pulmonary disease adverse outcomes mortality prognostic capacity biomarker |
| title | A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease |
| title_full | A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease |
| title_fullStr | A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease |
| title_full_unstemmed | A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease |
| title_short | A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease |
| title_sort | comprehensive systematic review and meta analysis of the association between the neutrophil to lymphocyte ratio and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease |
| topic | neutrophil-to-lymphocyte ratio acute exacerbation of chronic obstructive pulmonary disease adverse outcomes mortality prognostic capacity biomarker |
| url | https://www.mdpi.com/2077-0383/11/12/3365 |
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