title: The role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To investigate whether neutrophil-lymphocyte ratio and platelet-lymphocyte ratio like C-reactive protein can be used as markers of acute exacerbation in chronic obstructive pulmonary disease.
  
  
  METHODS
  The cross-sectional study was conducted at Konya Training and Research Hospital, Konya, Turkey, between December 2012 and April 2013, and comprised patients with stable and acute chronic obstructive pulmonary disease. All participants were male and aged >40 years. Patients were included prospectively from outpatient and emergency units according to recent Initiative for Chronic Obstructive Lung Disease 2013 criteria. C-reactive protein, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio of each group were measured and compared.
  
  
  RESULTS
  Of the 94 patients, 48(51%) had stable disease with a mean age of 66.65±10.17 years (range: 49-79 years), and 46(49%) had acute exacerbation with a mean age of 62.67±9.41 years (range: 48-92 years). Mean levels of C-reactive protein, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were 5.04±6.65, 2.75±1.11 and 137.39±65.42 for stable disease, and 57.68±58.49, 7.99±5.72 and 231.18±141.36 for those with acute exacerbation (p=0.001). Cut-off values were neutrophil-lymphocyte ratio =3.3, platelet-lymphocyte ratio =150, and C-reactive protein =5 mg/dl. Positive predictive values for C-reactive protein, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were determined as 82% (odds ratio: 27.4); 85% (odds ratio: 32.5); and 73% (odds ratio: 6.3) . Receiver-operating characteristic curve showed a significantly more area under curve of neutrophil-lymphocyte ratio (0.88) compared to platelet-lymphocyte ratio (0.74) (p<0.05).
  
  
  CONCLUSIONS
  During acute exacerbations of chronic obstructive pulmonary disease, neutrophil-lymphocyte ratio may be used as an easily measurable, available and cost-effective parameter with high prognostic accuracy in clinical practice.
authors.affiliation: Department of Chest Diseases, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Kurtipek
authors.affiliation: Department of Chest Diseases, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Taha Tahir
authors.initials: TT
authors.lastname: Bekci
authors.affiliation: Department of Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Recep
authors.initials: R
authors.lastname: Kesli
authors.affiliation: Department of Biochemistry, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Said Sami
authors.initials: SS
authors.lastname: Sami
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Terzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D018450:Disease Progression; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications* / Q000175:diagnosis; D012680:Sensitivity and Specificity
chemical_list: D002097:C-Reactive Protein
keywords: Chronic obstructive pulmonary disease, C-reactive protein, Neutrophil-lymphocyte ratio.