Clinical significance of mean platelet volume/lymphocyte ratio and mean platelet volume/platelet ratio in the exacerbation of chronic obstructive pulmonary disease

Objectives: Studies showing the role of systemic inflammation in chronic obstructive pulmonary disease(COPD) are increasing. Particularly, importance of mean platelet volume (MPV) and neutrophil/lymphocyteratio (NLR) for acute exacerbation of COPD has been reported. The use of MPV/lymphocyte ratio (MLR) andMPV/platelet ratio(MPR) in acute exacerbation of COPD patients was investigated in our study, consideringthat MPV alone may be a more valuable marker of inflammation.Methods: Between March 2017 and March 2018, COPD patients who applied to Abant Izzet Baysal UniversitySchool of Medicine, Chest Diseases outpatient clinic were examined. Results were retrospectively scannedfrom patient files after institutional approval. Sixty-four (60.4%) stable COPD and 42 (39.6%) acuteexacerbation COPD patients were included in the study.Results: Seventy-one (67%) of patients were male and 35 (33%) were female. NLR was 2.26 (0.93-6.48) instable patients and 4 (1.18-36) in acute attack patients (p < 0.001); PLR was 137.44 (66.9-436.6) in patientswith stable disease and 162.8 (85-1056.6) in patients with attack (p = 0.068). MLR was 5 (2.92-25) in acuteattack patients and 4 (1.89-8.67) in stable patients; this difference was statistically significant (p = 0.003). MPVwas found to be 7 (5.5-9.1) fL in patients with stable disease and 8 (5-13.4) fL in acute patients. This differencewas statistically significant (p < 0.001). MPR was found to be statistically significantly higher in acute patientsthan in patients with stable disease (p = 0.04). WBC, neutrophil and CRP were found to be statisticallysignificantly higher in acute patients than in stable patients (p < 0.05). There was a statistically significantcorrelation between WBC and NLR (r = 0.269, p = 0.005) and between CRP and NLR (r = 0.379, p < 0.001).Conclusions: Hemogram parameters from routine laboratory tests in COPD patients are cheap and easilyaccessible. It is important to detect the presence of subclinical inflammation in the stable phase, as well as toidentify patients at risk of exacerbation. Prospective studies are needed to demonstrate correlations withinflammatory markers.

PDF

___

[1] Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org
[2] Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012;67:957-63.
[3] Yousef AM, Alkhiary W. Role of neutrophil to lymphocyte ratio in prediction of acute exacerbation of chronic obstructive pulmonary disease. Egyptian J Chest Dis Tuberc 2017;66:43-8.
[4] Steiropoulos P, Papanas N, Nena E, Xanthoudaki M, Goula T, Froudarakis M, et al. Mean platelet volume and platelet distribution width in patients with chronic obstructive pulmonary disease: the role of comorbidities. Angiology 2013;64:535-9.
[5] Rahimi-Rad MH, Soltani S, Rabieepour M, Rahimirad S. Thrombocytopenia as a marker of outcome in patients with acute exacerbation of chronic obstructive pulmonary disease. Pneumonol Alergol Pol 2015;83:348-51.
[6] Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, et al. Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev 2018;27(147). pii:170113.
[7] Unsinger J, Kazama H, McDonough JS, Hotchkiss RS, Ferguson TA. Differential lymphopenia-induced homeostatic proliferation for CD4+ and CD8+ T cells following septic injury. J Leukoc Biol 2009;85:382-90.
[8] Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine 1987;106:196-204.
[9] Schols AM, Buurman WA, Staal van den Brekel AJ, Dentener MA, Wouters EF. Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 1996;51:819-24.
[10] Donaldson GC, Seemungal TA, Patel IS, Bhowmik A, Wilkinson TM, Hurst JR, et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 2005;128:1995-2004.
[11] Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Design 2011;17:47-58.
[12] Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, Lee K. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009;58:15-23.
[13] Hudzik B, Szkodziński J, Lekston A, Gierlotka M, Poloński L, Gąsior M. Mean platelet volume-to-lymphocyte ratio: a novel marker of poor short-and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications 2016;30:1097-102.
[14] Bansal R, Gupta HL, Goel A, Yadav M. Association of increased platelet volume in patients of chronic obstructive pulmonary disease: clinical implications. J Indian Acad Clin Med 2002;3:169-72.
[15] Ulasli SS, Ozyurek BA, Yilmaz EB, Ulubay G. Mean platelet volume as an inflammatory marker in acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Med Wewn 2012;122:284-90.
[16] Agapakis D, Massa V, Hantzis I, Maraslis S, Alexiou E, Imprialos P, et al. The role of mean platelet volume in chronic obstructive pulmonary disease exacerbation. Respir Care 2016;61:44-9.
[17] Wang RT, Li JY, Cao ZG, Li Y. Mean platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease. Respirology 2013;18:1244-8.
[18] Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volüme with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 2009;63:1509-15.
[19] Milovanovic M, Nilsson E, Järemo P. Relationships between platelets and inflammatory markers in rheumatoid arthritis. Clin Chim Acta 2004;343:237-40.
[20] Kurtipek E, Bekci TT, Kesli R, Sami SS, Terzi Y. The role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. J Pak Med Assoc 2015;65:1283-7.
[21] Karadeniz G, Aktoğu S, Erer OF, Kır SB, Doruk S, Demir M, et al. Predictive value of platelet-to-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. Biomark Med 2016;10:701-10.
[22] Thomsen M, Ingebrigtsen TS, Marott JL, Dahl M, Lange P, Vestbo J, et al. Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA 2013;309:2353- 61.
[23] Kocak MZ, Fidan K. Could the neutrophil-to-lymphocyte ratio be a marker of acute inflammation in chronic obstructive pulmonary disease? Eurasian J Med Invest 2018;2:8-11.
[24] Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7.
[25] Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophiland platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab 2015;61:269-73.
[26] Günay E, Sarınç Ulaşlı S, Akar O, Ahsen A, Günay S, Koyuncu T, et al. Neutrophil-tolymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation 2014;37:374-80.
[27] Terradas R, Grau S, Blanch J, Riu M, Saballs P, Castells X. Eosinophil count and neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PLoS One 2012;7:e42860.
[28] Göçmen H, Çoban H, Yıldız A, Ursavaş A, Coşkun F, Ediger D. Is there any correlation between serum CRP level and haematological parameters wıth severity of disease in acute exacerbation of COPD? Respir Dis 2007;18:141-7.
[29] Gao P, Zhang J, He X, Hao Y, Wang K, Gibson PG. Sputum inflammatory cell-based classification of patients with acute exacerbation of chronic obstructive pulmonary disease. PLoS One 2013;31:e57678.