Egyptian Journal of Chest Disease and Tuberculosis (Oct 2017)
The refined ABCD assessment and non-costly laboratory parameters are outcome predictors in acute exacerbation of COPD
Abstract
Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is common problem in clinical practice. Despite relatively new infection markers such as procalcitonin, copeptin and endothelin-1 revealed promising results in the estimation of infection risk and outcome prediction, their use is notably limited by factors as cost, availability and validation. So in the low income countries, it is advisable to re-explore the value of the inexpensive investigations. Objectives: Our study primarily aimed at more validation of the updated GOLD grouping of COPD by evaluating its prognostic role during AECOPD. In addition, in the search for a non-invasive and easily measurable laboratory parameter that might reflect systemic inflammation, we investigated the role of Neutrophil Lymphocyte ratio (NLR) and Thrombocytopenia (TP) in predicting un-favorable outcome. Methods: This study enrolled 80 patients with a diagnosis of COPD exacerbation admitted to the inpatient chest department, Sohag University hospital. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), random blood glucose, serum creatinine and arterial blood gases were done within 2 h of hospital admission. ABCD assessment and Severity of airflow limitation were determined. Results: Neutrophil Lymphocyte ratio (NLR), Blood glucose, serum creatinine, Partial pressure of carbon dioxide, ESR, airflow limitation severity and length of stay (LOS) showed significant difference in the four GOLD groups. For an NLR cutoff of 3.4, sensitivity for predicting unfavorable outcome of AECOPD was 88.89% and specificity was 40.07% ((AUC 0.642, p0.023) A platelets cutoff of 169, sensitivity was 40.7% (AUC 0.657, p0.024). For pco2 cutoff of 54, sensitivity was 70.37% (AUC 0.781, p 0.000). Conclusions: Elevated NLR can be used as a marker similar to ESR, in the determination of increased inflammation in acutely exacerbated COPD.A prognostic role was recognized for the ABCD GOLD categories. So when we faced by a patient with AECOPD, putting the clinical evaluation, including his gold category, side by side to the simple laboratory data will give good idea about the likely prognosis.
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