Mortality Predictors in Patients with Severe COPD Exacerbation

Background: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of intensive care unit (ICU) admissions and in-hospital mortality. Several hematological inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), and systemic immune-inflammation index (SII), have been proposed as markers of disease severity and mortality. Methods: A retrospective study was conducted on 104 ICU patients with AECOPD over a two-year period. We collected and analyzed clinical, demographic, and laboratory data. The hematological indices of the two groups-survivors (n = 39) and non-survivors (n = 65)-were compared to assess differences. We used t-tests, ANOVA, chi-square tests, and Mann-Whitney U tests to compare the groups. The factors that independently predicted mortality were identified using multivariate logistic regression. We examined survival differences using Kaplan-Meier analysis, and ROC curves were utilized to evaluate the predictive power of each biomarker. Results: Mortality was substantially predicted by higher SII (OR: 1.92, 95% CI: 1.24-3.08, p = 0.002) and NLR (OR: 2.89, 95% CI: 1.72-4.82, p < 0.001). Patients with NLR > 8.0 and SII > 1800 had significantly lower survival rates (log-rank p < 0.001), according to Kaplan-Meier analysis. SII (AUC = 0.79) and NLR (AUC = 0.82) were the best predictors of death, according to ROC analysis. Conclusions: In ICU-admitted AECOPD patients, NLR, MLR, PLR, dNLR, and SII are independent predictors of mortality. Due to their ease of evaluation and predictive capabilities, they should be included in ICU risk models for early interventions.