Abstract:

Objective: To analyze the evaluative value of combined detection of multiple inflammatory biomarkers for disease severity and short-term prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A retrospective study was conducted. A total of 60 elderly AECOPD patients admitted to the Hospital of Chinese People’s Armed Police Force Xinjiang Corps from January 2023 to December 2025 were enrolled as study subjects. The patients were divided into a mild-to-moderate group (32 cases) and a severe and very severe group (28 cases) according to disease severity; into a favorable prognosis group (47 cases) and a poor prognosis group (13 cases) based on 30-day prognosis; and into a low comorbidity group (0-1 comorbidity; 27 cases) and a high comorbidity group (≥2 comorbidities; 33 cases) by the number of comorbidities. Data of peripheral blood neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) and eosinophil (EOS) level within 24 hours after admission were collected, and inter-group differences were compared. Multivariate logistic regression was applied to identify independent risk factors for short-term poor prognosis, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of different models. Results: The severe and very severe group had higher NLR (6.9 (6.1, 7.9)) and SII (950 (880, 1050)) than the mild-to-moderate group (3.8 (3.1, 4.6) and 610 (560, 690), respectively), and lower EOS (0.22 (0.18, 0.26)×10⁹/L) than the mild-to-moderate group (0.39 (0.35, 0.45)×10⁹/L). All differences were statistically significant (U=48.500, 32.000, 67.000, respectively; all P<0.001, retained to three decimal places). The poor prognosis group had higher NLR (8.7 (7.9, 9.5)) and SII (1120 (1010, 1280)) than the favorable prognosis group (5.0 (4.2, 5.9) and 760 (670, 860), respectively), and lower EOS (0.19 (0.16, 0.22)×10⁹/L) than the favorable prognosis group (0.40 (0.35, 0.46)×10⁹/L), with statistically significant differences (U=12.000, 10.500, 25.000, respectively; all P<0.001). Multivariate logistic regression analysis showed that high comorbidity burden (OR=3.25, 95%CI: 1.12-9.42), elevated NLR (OR=2.10, 95%CI: 1.35-3.27), elevated SII (OR=1.45, 95%CI: 1.12-1.88) and decreased EOS (OR=2.80, 95%CI: 1.30-6.02) were independent risk factors for 30-day poor prognosis in elderly AECOPD patients. ROC curve analysis revealed that the area under the curve (AUC) of the combined assessment of NLR, SII and EOS for short-term poor prognosis was 0.914 (95%CI: 0.847-0.981), which was significantly higher than that of single indicators (NLR: 0.782 (95%CI:0.674-0.890); SII: 0.805 (95%CI:0.701-0.909); EOS: 0.751 (95%CI:0.638-0.864)). Conclusion: Combined detection of NLR, SII and EOS can significantly improve the accuracy of disease stratification and short-term prognosis evaluation in elderly AECOPD patients. High comorbidity burden further exacerbates the systemic inflammatory response in elderly AECOPD patients. The combined assessment of NLR, SII and EOS can provide objective evidence for comprehensive clinical evaluation of patient conditions and early intervention.

Key words: Aged, Pulmonary disease, chronic obstructive, Leukocytes, Prognosis, Retrospective studies