Does Mean Platelet Volume/Platelet Count Ratio and Red Rlood Cell Distribution Width Predict In-hospital Mortality in Patients Admitted for Acute Exacerbation of Chronic Obstructive Pulmonary Disease?

Year 2019, Volume: 4 Issue: 2, 18 - 25, 30.06.2019

Gülseren Yilmaz , Ziya Salihoglu

Abstract

Background:
The critical role of inflammation in increasing the frequency and the severity
of the exacerbations has been demonstrated previously. Some previous research
indicates that simple blood tests of inflammation such as neutrophil–lymphocyte
ratio (NLR) and platelet–lymphocyte ratio (PLR) performed at admission might
predict the severity of exacerbation and resultant outcomes. The purpose of the
present study was to investigate the role of MPV/PLT and other parameters of
complete blood count (CBC) in predicting in-hospital mortality in patients with
AECOPD.

Materials
and Methods: 171 patients admitted to the
intensive care unit of our institute -a tertiary center- with acute
exacerbation of COPD between May 2014 and August 2018 were retrospectively recruited
in the study. Demographic and clinical data including age, gender, accompanying
chronic diseases, spirometric data, and pretreatment laboratory test results were
extracted from the institutional digital database. The study population was
divided into two groups according to the development of in-hospital mortality
as survivors or non-survivors.

Results:  Thirty-six subjects died during the
in-hospital course (non-survivors) and 135 survived (survivors). Non-survivors
had higher C-reactive protein (p<0.001), NLR (p=0.037), PLR (p=0.021), mean
platelet volume (p<0.001), and MPV/PLT (p=0.004) compared to survivors. Admission
pH was significantly lower in no-survivors that survivors p<0.001. Logistic
regression analysis revealed that among several variables, GOLD stage > 2 (OR:
2.222, 95 % CI: 1.196-4.128, p=0.012), admission CRP (OR: 1.158), RDW (OR: 2.327),
pH (OR: 0.002), NLR (OR: 1.902), and MPV/PLT (OR: OR: 1.332) were independent
predictors of in-hospital mortality in patients with AECOPD. ROC curve analysis
indicated a cut of value of 43.57 (sensitivity 67%, specifity 66%) for CRP,
15.4 % for RDW (sensitivity 74 %, specifity 75 %), 3.18 for NLR (sensitivity 71
%, specifity 72 %), and 4.45 for MPV/PLT (sensitivity 67 %, specifity 68%) to
predict in hospital-mortality in patients with AECOPD

Conclusions:
MPV/PLT, as an emerging indicator of preexisting inflammation, and RDW
indicating intermittent hypoxemia, independently predict in-hospital mortality
in patients with AECOPD. Implementation of MPV/PLT and RDW in addition to GOLD
stage, pH, NLR and CRP might be useful in identifying patients who will require
advanced support during admission for AECOPD.  

Keywords

Acute exacerbation of chronic obstructive pulmonary disease, in-hospital mortality, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, red blood cell distribution width

References

• 1. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-210.2. Liu S, Zhou Y, Wang X, Wang D, Lu J, Zheng J, et al. Biomass fuels are the probable risk factor for chronic obstructive pulmonary disease in rural South China. Thorax. 2007;62(10):889-97.3. Lorenz J, Bals R, Dreher M, Jany B, Koczulla R, Pfeifer M, et al. [Exacerbation of COPD]. Pneumologie (Stuttgart, Germany). 2017;71(5):269-89.4. Halpin DM, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. International journal of chronic obstructive pulmonary disease. 2017;12:2891-908.5. Pavord ID, Jones PW, Burgel PR, Rabe KF. Exacerbations of COPD. International journal of chronic obstructive pulmonary disease. 2016;11 Spec Iss:21-30.6. Sakamoto Y, Yamauchi Y, Yasunaga H, Takeshima H, Hasegawa W, Jo T, et al. Development of a nomogram for predicting in-hospital mortality of patients with exacerbation of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2017;12:1605-11.7. Yao C, Liu X, Tang Z. Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. International journal of chronic obstructive pulmonary disease. 2017;12:2285-90.8. Aksoy E, Karakurt Z, Gungor S, Ocakli B, Ozmen I, Yildirim E, et al. Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes. International journal of chronic obstructive pulmonary disease. 2018;13:2721-30.9. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347-65.10. Flattet Y, Garin N, Serratrice J, Perrier A, Stirnemann J, Carballo S. Determining prognosis in acute exacerbation of COPD. International journal of chronic obstructive pulmonary disease. 2017;12:467-75.11. Bartziokas K, Papaioannou AI, Loukides S, Papadopoulos A, Haniotou A, Papiris S, et al. Serum uric acid as a predictor of mortality and future exacerbations of COPD. Eur Respir J. 2014;43(1):43-53.12. Pavasini R, d'Ascenzo F, Campo G, Biscaglia S, Ferri A, Contoli M, et al. Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: Systematic review and meta-analysis. Int J Cardiol. 2015;191:187-93.13. Zhang J, Bai C. The Significance of Serum Interleukin-8 in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Tanaffos. 2018;17(1):13-21.14. Rahimirad S, Ghaffary MR, Rahimirad MH, Rashidi F. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease. Tuberkuloz ve toraks. 2017;65(1):25-31.15. Teng F, Ye H, Xue T. Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. PLoS One. 2018;13(9):e0204377.16. Seyhan EC, Ozgul MA, Tutar N, Omur I, Uysal A, Altin S. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease. Copd. 2013;10(4):416-24.17. Tertemiz KC, Ozgen Alpaydin A, Sevinc C, Ellidokuz H, Acara AC, Cimrin A. Could "red cell distribution width" predict COPD severity? Revista portuguesa de pneumologia. 2016;22(4):196-201.18. Epstein D, Nasser R, Mashiach T, Azzam ZS, Berger G. Increased red cell distribution width: A novel predictor of adverse outcome in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 2018;136:1-7.19. Ates S, Oksuz H, Dogu B, Bozkus F, Ucmak H, Yanit F. Can mean platelet volume and mean platelet volume/platelet count ratio be used as a diagnostic marker for sepsis and systemic inflammatory response syndrome? Saudi Med J. 2015;36(10):1186-90.20. Quan W, Chen Z, Yang X, Li J, Li X, Weng Y, et al. Mean platelet volume/platelet count ratio as a predictor of 90-day outcome in large artery atherosclerosis stroke patients. The International journal of neuroscience. 2017;127(11):1019-27.21. Bolat I, Akgul O, Cakmak HA, Pusuroglu H, Somuncu U, Ozbey S, et al. The prognostic value of admission mean platelet volume to platelet count ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Kardiol Pol. 2016;74(4):346-55.22. Perng DW, Chen PK. The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease. Tuberculosis and respiratory diseases. 2017;80(4):325-35.23. Kawamatawong T, Apiwattanaporn A, Siricharoonwong W. Serum inflammatory biomarkers and clinical outcomes of COPD exacerbation caused by different pathogens. International journal of chronic obstructive pulmonary disease. 2017;12:1625-30.24. Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2011;6:157-69.25. Iannacone M. Platelet-mediated modulation of adaptive immunity. Seminars in immunology. 2016;28(6):555-60.26. Orfanu AE, Popescu C, Leustean A, Negru AR, Tiliscan C, Arama V, et al. The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients. J Crit Care Med (Targu Mures). 2017;3(3):105-10.