open access
Diagnostic value of neutrophil to lymphocyte ratio to rule out chronic obstructive pulmonary disease exacerbation from acute heart failure in the emergency department
, 2
Affiliations- Sivas Cumhuriyet University, Faculty of Medicine, Department of Emergency Medicine, Sivas, Turkey
- Department of Family Medicine, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
open access
Abstract
INTRODUCTION: This study was performed to determine whether neutrophil-lymphocyte ratio (NLR) optimizes the differential diagnosis of acute chronic obstructive pulmonary disease (COPD) exacerbation and acute heart failure (AHF) in patients admitting to the emergency department (ED) with dyspnoea.
MATERIAL AND METHODS: The study group included 241 patients (135 males and 106 females) who were admitted to the ED with a complaint of dyspnoea between January 2016 November 2018 and were hospitalized with diagnosis of acute COPD exacerbation or AHF.
RESULTS: White blood cell count, neutrophil, haemoglobin, haematocrit, NLR, and C-reactive protein values in patients with COPD exacerbation were significantly higher compared to those with AHF (p < 0.05). The largest areas under the ROC curve were obtained with NLR. The cut-off value for NLR was 9.39, with a sensitivity of 71% and a specificity of 61%.
CONCLUSIONS: In conclusion, the NLR has diagnostic value to the conventional clinical assessment in patients with acute dyspnoea at ED, especially with acute COPD exacerbation requiring inpatient management. This may be an additional tool during the differential diagnosis of dyspnoea for emergency physicians in hospitals without advanced laboratory facilities.
Abstract
INTRODUCTION: This study was performed to determine whether neutrophil-lymphocyte ratio (NLR) optimizes the differential diagnosis of acute chronic obstructive pulmonary disease (COPD) exacerbation and acute heart failure (AHF) in patients admitting to the emergency department (ED) with dyspnoea.
MATERIAL AND METHODS: The study group included 241 patients (135 males and 106 females) who were admitted to the ED with a complaint of dyspnoea between January 2016 November 2018 and were hospitalized with diagnosis of acute COPD exacerbation or AHF.
RESULTS: White blood cell count, neutrophil, haemoglobin, haematocrit, NLR, and C-reactive protein values in patients with COPD exacerbation were significantly higher compared to those with AHF (p < 0.05). The largest areas under the ROC curve were obtained with NLR. The cut-off value for NLR was 9.39, with a sensitivity of 71% and a specificity of 61%.
CONCLUSIONS: In conclusion, the NLR has diagnostic value to the conventional clinical assessment in patients with acute dyspnoea at ED, especially with acute COPD exacerbation requiring inpatient management. This may be an additional tool during the differential diagnosis of dyspnoea for emergency physicians in hospitals without advanced laboratory facilities.
Keywords
neutrophil-lymphocyte ratio; dyspnoea; acute COPD exacerbation; acute heart failure; emergency medicine
About this articleTitle
Diagnostic value of neutrophil to lymphocyte ratio to rule out chronic obstructive pulmonary disease exacerbation from acute heart failure in the emergency department
Journal
Disaster and Emergency Medicine Journal
Issue
Article type
Research paper
Pages
102-108
Published online
2019-10-08
Page views
806
Article views/downloads
710
DOI
Bibliographic record
Disaster Emerg Med J 2019;4(3):102-108.
Keywords
neutrophil-lymphocyte ratio
dyspnoea
acute COPD exacerbation
acute heart failure
emergency medicine
Authors
Erdal Demirtaş
Esin Demirtaş
References (22)- MeiLan King Han MK, Dransfield MT, Martinez JF. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. Hollingsworth H (ed.) UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (22.12.2018).
- Stokes NR, Dietz BW, Liang JJ. Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea. Open Access Emerg Med. 2016; 8: 35–45.
- Wettersten N, Maisel AS. Biomarkers for Heart Failure: An Update for Practitioners of Internal Medicine. Am J Med. 2016; 129(6): 560–567.
- Peacock WF, De Marco T, Fonarow GC, et al. ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008; 358(20): 2117–2126.
- Teng F, Ye H, Xue T. Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. PLoS One. 2018; 13(9): e0204377.
- de Jager CPC, van Wijk PTL, Mathoera RB, et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010; 14(5): R192.
- Aksoy E, Karakurt Z, Gungor S, et al. Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes. Int J Chron Obstruct Pulmon Dis. 2018; 13: 2721–2730.
- Gheorghiade M, Zannad F, Sopko G, et al. International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005; 112(25): 3958–3968.
- Pesola GR, Forde AT, Ahsan H. Screening for Shortness of Breath: Stretching the Screening Paradigm to Tertiary Prevention. Am J Public Health. 2017; 107(3): 386–388.
- Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management and prevention of Chronic Obstructive Pulmonary Disease. (2017 REPORT). http://www.goldcopd.org.
- Kleinschmidt P. Chronic Obstructive Pulmonary Disease (COPD) and Emphysema in Emergency Medicine. https://emedicine.medscape.com/article/807143-overview#a3 (28.12.2018).
- Hurst JR, Vestbo J, Anzueto A, et al. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010; 363(12): 1128–1138.
- Fabbri LM, Beghé B, Agusti A. Cardiovascular mechanisms of death in severe COPD exacerbation: time to think and act beyond guidelines. Thorax. 2011; 66(9): 745–747.
- Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129–2200.
- Hawkins NM, Petrie MC, Jhund PS, et al. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009; 11(2): 130–139.
- Tung RH, Camargo CA, Krauser D, et al. Amino-terminal pro-brain natriuretic peptide for the diagnosis of acute heart failure in patients with previous obstructive airway disease. Ann Emerg Med. 2006; 48(1): 66–74.
- Kelly AM, Holdgate A, Keijzers G, et al. Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study. Respirology. 2018; 23(7): 681–686.
- Laribi S, Keijzers G, van Meer O, et al. AANZDEM and EURODEM study groups. Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region. Eur J Emerg Med. 2019; 26(5): 345–349.
- Gori CS, Magrini L, Travaglino F, et al. Role of biomarkers in patients with dyspnea. Eur Rev Med Pharmacol Sci. 2011; 15(2): 229–240.
- Stoica A, Şorodoc V, Lionte C, et al. Acute cardiac dyspnea in the emergency department: diagnostic value of N-terminal prohormone of brain natriuretic peptide and galectin-3. J Int Med Res. 2019; 47(1): 159–172.
- Morrison LK, Harrison A, Krishnaswamy P, et al. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002; 39(2): 202–209.
- Taylan M, Demir M, Kaya H, et al. Alterations of the neutrophil-lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients. Clin Respir J. 2017; 11(3): 311–317.