Journal article
Neutrophil-to-Lymphocyte Ratio (NLR) as a Biomarker in Clinically Stable Chronic Obstructive Pulmonary Disease: SPIROMICS cohort
Annals of the American Thoracic Society, Vol.22(12), pp.1881-1890
12/2025
DOI: 10.1513/AnnalsATS.202412-1265OC
PMCID: PMC12700239
PMID: 40920896
Abstract
Inflammation is central to chronic obstructive pulmonary disease (COPD) pathogenesis but incompletely represented in COPD prognostic models. Neutrophil to lymphocyte ratio (NLR) is a readily available inflammatory biomarker.
To explore the associations of NLR with smoking status, clinical features of COPD, and future adverse outcomes.
We analyzed NLR calculated from the complete blood count of participants who currently or formerly smoked (n = 2,624) and tobacco-naïve controls (n = 187) in the SPIROMICS multicenter observational cohort study. We assessed the stability of NLR at 6 weeks and 1 year, the association with select blood biomarkers, and the impact of smoking on NLR and cell counts. We stratified participants by NLR quartiles to compare cross-sectional clinical features at enrollment, prospectively observed exacerbations at 1 year, and mortality during longitudinal follow-up.
Higher NLR quartiles were broadly associated with more severe clinical features of COPD. NLR values were repeatable at 6 weeks (ICC=0.74) and 1 year (ICC=0.62). The impact of smoking on NLR varied with the severity of airflow limitation, mediated by an interaction between smoking, FEV1 % predicted, and neutrophil counts but not lymphocyte counts. The highest NLR quartile (>3.11) was associated with an increased risk of exacerbation over 1-year (adjusted OR=1.51 95%CI 1.18, 1.92) and increased risk of mortality (adjusted HR=1.41, 95%CI 1.20, 1.66) compared to quartiles 1-3.
Elevated NLR in stable COPD is a widely available biomarker associated with increased risk for exacerbation and death. The impact of cigarette smoking on NLR varies with disease severity.
Details
- Title: Subtitle
- Neutrophil-to-Lymphocyte Ratio (NLR) as a Biomarker in Clinically Stable Chronic Obstructive Pulmonary Disease: SPIROMICS cohort
- Creators
- Daniel T HoestereyHong Dang - Lung InstituteDaniela Markovic - Ronald Reagan UCLA Medical CenterRussell G Buhr - University of California, Los AngelesDonald P Tashkin - University of California, Los AngelesR Graham Barr - Columbia UniversityJohn A Belperio - UCLA HealthRussell P Bowler - National Jewish HealthEugene R Bleecker - University of ArizonaDavid J Couper - University of North Carolina at Chapel HillGerard G Criner - Temple UniversityChristopher B Cooper - Harbor–UCLA Medical CenterClaire M Doerschuk - Rainbow Babies & Children's HospitalMark T Dransfield - University of Alabama at BirminghamM Bradley Drummond - University of North Carolina at Chapel HillAshraf Fawzy - Johns Hopkins HospitalChristine M Freeman - University of MichiganMeiLan K Han - Michigan MedicineNadia N Hansel - Johns Hopkins UniversityAnnette T Hastie - Wake Forest UniversityEric A Hoffman - University of IowaYvonne J Huang - University of MichiganRobert J Kaner - Cornell UniversityRichard E Kanner - University of UtahVictor Kim - Temple UniversityJerry A Krishnan - University of Illinois ChicagoFernando J Martinez - Cornell UniversityWanda K O'Neal - University of North Carolina at Chapel HillVictor E Ortega - Mayo Clinic in ArizonaRobert Paine III - University of UtahAbhishek K Shrivastav - Mayo Clinic in ArizonaJ Michael Wells - University of Alabama at BirminghamPrescott G Woodruff - University of California, San FranciscoJeffrey L Curtis - Michigan MedicineIgor Barjaktarevic - University of California, Los Angeles
- Resource Type
- Journal article
- Publication Details
- Annals of the American Thoracic Society, Vol.22(12), pp.1881-1890
- DOI
- 10.1513/AnnalsATS.202412-1265OC
- PMID
- 40920896
- PMCID
- PMC12700239
- NLM abbreviation
- Ann Am Thorac Soc
- ISSN
- 2329-6933
- eISSN
- 2325-6621
- Publisher
- AMER THORACIC SOC
- Grant note
- L30 HL134025 / NHLBI NIH HHS
- Language
- English
- Electronic publication date
- 09/08/2025
- Date published
- 12/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984962541002771
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