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

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