Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION: The prognostic significance of neutrophil-to-lymphocyte ratio (NLR), derived-neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have been shown in many diseases. To the best of our knowledge, there is no published report evaluation of those parameters in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aims of this study are to evaluate the parameters in predicting in-hospital mortality in patients with AECOPD. MATERIALS AND METHODS: This is a retrospective study in two referral hospitals in Tabriz and Urmia, Iran. NLRs, PLR, LMR, and d-NLR were calculated from the admission day complete blood count of patients with AECOPD. Comparison was made between patients who died in hospital and those discharged alive. RESULT: Of 315 patients, 70 (22.2%) died in the hospital and 245 (77.8%) were discharged alive. The mortality rate was higher in patients with NLR ≥ 4 than with NLR < 4 (24% vs. 9.5% p value < 0.001). Multivariate analysis revealed NLR (p= 0.001) were independently associated with in-hospital mortality. NLR had the highest odds ratio for death both in univariate (OR= 3.80) and multivariate (OR= 3.50) analyses. The area under the receiver-operating characteristic curve for NLR in predicting in-hospital death was 0.72 (95% CI: 0.62-0.81; p< 0.001). PLR and LMR did not show significant relation to in-hospital death in AECOPD. CONCLUSIONS: This study shows for the first time that higher NLR is positively associated with in-hospital mortality in AECOPD.

The avian influenza H9N2 at avian-human interface: A possible risk for the future pandemics.

The avian influenza subtype H9N2 is considered a low pathogenic virus which is endemic in domestic poultry of a majority of Asian countries. Many reports of seropositivity in occupationally poultry-exposed workers and a number of confirmed human infections with an H9N2 subtype of avian influenza have been documented up to now. Recently, the human infections with both H7N9 and H10N8 viruses highlighted that H9N2 has a great potential for taking a part in the emergence of new human-infecting viruses. This review aimed at discussing the great potential of H9N2 virus which is circulating at avian-human interface, for cross-species transmission, contribution in the production of new reassortants and emergence of new pandemic subtypes. An intensified surveillance is needed for controlling the future risks which would be created by H9N2 circulation at avian-human interfaces.

Elevated red blood cell distribution width predicts mortality in acute exacerbation of COPD.

Objective: Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in many diseases. To our knowledge, the prognostic significance of RDW in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has not been reported so far. The aim of the present study is to investigate the relation of RDW to in-hospital mortality in patients with AECOPD. Methods: We retrospectively reviewed hospital records of inpatients with AECOPD in two referral teaching hospitals in two provinces of east Azerbaijan and west Azerbaijan, Iran. Associations between RDW and in-hospital death were analyzed with using correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves is SPSS software. Results: We studied 330 patients, of whom 75 (22.7%) did not survive to hospital discharge. In univariate analysis higher RDW-SD values were associated with increased hospital mortality (30.2% vs. 15.8% p=0.002 odds ratio 2.31). Using the first quartile of RDW as reference, odds ratio (OR) mortality among patients in the highest RDW quartile was 5.34 (95%CI, 2.70-12.57;9=0.001). In multivariate analysis RDW-SD remained an independent risk factor for mortality after correction for age, thrombocytopenia, leukocyte count, mean corpuscular volume, anemia. In receiver-operating curve analysis the AUC for RDW was 0.663, which was more than that of hemoglobin, platelets. Conclusion: RDW on admission day proves to be a useful indicator to predict in-hospital death in AECOPD.