Prognostic Significance of Neutrophil/Lymphocyte Ratio and SOFA Score in Patients with Chronic Obstructive Pulmonary Disease Followed in Intensive Care Unit

Öz

Objective: Chronic Obstructive Pulmonary Disease (COPD) has become one of the leading causes of increasing morbidity and mortality worldwide. Inflammation is known to play an important role in the pathogenesis of COPD. Neutrophil-lymhocyte ratio (NLR) is an inflammatory biomarker which indicates the balance of the immune system and reflecting systemic inflammation. One of the most commonly used scoring models for predicting mortality in intensive care is the Sepsis Organ Failure Assessment (SOFA) scoring. The aim of our study is to investigate the prognostic significance of NLR and SOFA score in patients admitted to the intensive care unit (ICU) with COPD. Methods: A retrospective, single-center cohort study was conducted between 01.09.2022-01.09.2024. Patients over the age of 18 who were admitted to the intensive care unit of Kırşehir Training and Research Hospital with a diagnosis of COPD. Data of age, gender, comorbidities, SOFA score, NLR, number of invasive and non-invasive mechanical ventilation days, length of hospital stay, length of ICU stay, and 30-day mortality. Logistic regression analysis was used to predict mortality. Results: Data from 259 patients were evaluated. The mean age of the patients was 72 (14). Sixty-seven patients died and 192 patients were discharged. β coefficient for the NLR was 0.014419 (p=0.0383). β coefficient for the SOFA score was 0.382920 (p<0.001). From the ROC (Receiver Operating Characteristic) curve, it appears that the model has a high AUC (Area Under Curve), which indicates that the model is quite good at distinguishing classes. SOFA score and NLR were found to be higher in deceased patients. Conlusion: In ICU follow-up, SOFA score and NLR can be examined together to early detect critically COPD patients and predict mortality.

Anahtar Kelimeler

• COPD
• SOFA( The Sepsis Organ Failure Assessment) score
• Neutrophil-lymhocyte ratio(NLR)
• ICU
• mortality

Yoğun Bakım Ünitesinde Kronik Obstrüktif Akciğer Hastalığı Tanısıyla Takip Edilen Hastalarda Nötrofil /Lenfosit Oranı ve SOFA Skorunun Prognostik Önemi

Öz

Amaç Kronik Obstrüktif Akciğer Hastalığı(KOAH), dünya çapında artan morbidite ve mortalitenin önde gelen nedenlerinden biri haline gelmiştir. İnflamasyonun KOAH patogenezinde önemli bir rol oynadığı bilinmektedir. Nötrofil-lenfosit oranı (NLR), bağışıklık sisteminin dengesini gösteren ve sistemik inflamasyonu yansıtan bir inflamatuar biyobelirteçtir. Yoğun bakımda mortalite tahmininde en çok kullanılan skorlama modellerinden biri Sepsis Organ Yetmezliği Değerlendirme (SOFA) skorlamasıdır. Çalışmamızın amacı, KOAH nedeniyle yoğun bakıma yatırılan hastalarda NLR ve SOFA skorunun prognostik önemini araştırmaktır. Yöntem 01.09.2022-01.09.2024 tarihleri arasında KOAH nedeni ile yoğun bakım unitesine yatırılan 18 yaş üstü hastalar retrospektif olarak incelendi. Yaş, cinsiyet, eşlik eden hastalıklar, SOFA skoru, NLR, invaziv ve noninvaziv mekanik ventilasyon gün sayısı, hastanede kalış süresi, yoğun bakımda kalış süresi ve 30 günlük mortalite verileri incelendi. Bulgular 259 hastadan alınan veriler değerlendirildi. Hastaların ortalama yaşı 72 idi(14). 67 hasta ex oldu, 192 hasta taburcu edildi. NLR için β katsayısı 0,014419 idi (p = 0,0383). SOFA skoru için β katsayısı 0,382920 idi (p < 0,001). ROC Eğrisinden, modelin yüksek bir AUC'ye sahip olduğu görünmektedir bu da modelin sınıfları ayırt etmede oldukça iyi olduğunu gösterir. Ölen hastalarda SOFA skoru ve NLR'nin daha yüksek olduğu bulundu. Sonuç Yoğun bakım takibinde, kritik KOAH hastalarının erken teşhisi ve mortalitenin öngörülmesi için SOFA skoru ve NLR birlikte incelenebilir.

Anahtar Kelimeler

• KOAH
• SOFA( The Sepsis Organ Failure Assessment) skoru
• Nötrofil/Lenfosit oranı(NLR)
• YBÜ
• ölüm

Kaynakça

1. Xiao K, Guo C, Su L, Yan P, Li X, Xie L. Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation. Journal of thoracic disease. 2015;7(3):329.
2. Akhter S, Warraich UA, Ghazal S, Rizvi N. Assessment and comparison of APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment) score and curb 65 (confusion; urea; respiratory rate; blood pressure), for prediction of inpatient mortality in acute exacerbation of chronic obstructive pulmonary disease. JPMA. 2019;69(2):211-215.
3. Celli BR, Fabbri LM, Aaron SD, et al. An updated definition and severity classification of chronic obstructive pulmonary disease exacerbations: the Rome proposal. American journal of respiratory and critical care medicine. 2021;204(11):1251-1258.
4. Maurya KK, Singh S, Rapelly SS, Verma AK. Association of neutrophil-to-lymphocyte ratio and CRP with spirometry in COPD patients in North India. Journal of Family Medicine and Primary Care. 2025;14(3):867-873.
5. Nathan C. Neutrophils and immunity: challenges and opportunities. Nature reviews immunology. 2006;6(3):173-182.
6. Bilir B, Altıntas N, Aydin M, Oran M, Ozsu S, Tutar U. The predictive role of neutrophil to lymphocyte ratio in chronic obstructive pulmonary disease. European Journal of General Medicine. 2016;13(2)
7. Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Critical Care. 2019;23:1-9.
8. Rodríguez A, Lisboa T, Solé-Violán J, et al. Impact of nonexacerbated COPD on mortality in critically ill patients. Chest. 2011;139(6):1354-1360.

9. Cırık MÖ, Baldemir R, Doğanay GE, Ünver M, Avcı S. The 30-day mortality predictor role of c-reactive protein/albumin ratio in critically ill COPD patients. Critical Care Innovations. 2020;3(4):1-12. Xie J, Liu H, He Q, Li C. Relationship between lactate-to-albumin ratio and 28-day mortality in patients with exacerbation of chronic obstructive pulmonary disease admitted to the Intensive Care Unit. European Journal of Medical Research. 2024;29(1):258.
10. Tanrıverdi H, Örnek T, Erboy F, et al. Comparison of diagnostic values of procalcitonin, C-reactive protein and blood neutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD. Wiener Klinische Wochenschrift. 2015;127
11. Paliogiannis P, Fois AG, Sotgia S, et al. The neutrophil‐to‐lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta‐analysis. European Journal of Clinical Investigation. 2018;48(8):e12984.
12. Pascual-Gonzalez Y, Lopez-Sanchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review. International journal of chronic obstructive pulmonary disease. 2018:3651-3662.
13. Cai C, Zeng W, Wang H, Ren S. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers in diagnosis evaluation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: a retrospective, observational study. International Journal of Chronic Obstructive Pulmonary Disease. 2024:933-943.
14. Liao Q-Q, Mo Y-J, Zhu K-W, et al. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and eosinophil-to-lymphocyte ratio (ELR) as biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). International Journal of Chronic Obstructive Pulmonary Disease. 2024:501-518.
15. Doganay GE, Cirik MO, Doganay GE. Are neutrophil-lymphocyte, platelet-lymphocyte, and monocyte-lymphocyte ratios prognostic indicators in patients with chronic obstructive pulmonary disease in intensive care units? Cureus. 2022;14(3)