{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:48:48Z","timestamp":1782139728348,"version":"3.54.5"},"reference-count":16,"publisher":"FapUNIFESP (SciELO)","issue":"3","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: Systemic inflammation is closely associated with acute exacerbations of chronic obstructive pulmonary disease and may reflect the risk of future exacerbations. Blood-based inflammatory biomarkers represent simple and practical tools for identifying patients at increased risk. The aim of this study was to evaluate the association between systemic inflammatory biomarkers measured during stable chronic obstructive pulmonary disease and overall exacerbation burden across Global Initiative for Chronic Obstructive Lung Disease stages.  METHODS: This retrospective cohort study included 132 patients with chronic obstructive pulmonary disease followed for at least 2 years. Clinical, functional, and laboratory data obtained during clinically stable periods were analyzed. Systemic inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, aggregate index of systemic inflammation, and modified Glasgow prognostic score) were calculated. Exacerbation frequency was defined as the annualized number of moderate-to-severe exacerbations. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease groups A, B, and E, and associations between inflammatory biomarkers and clinical outcomes were evaluated using appropriate statistical methods, including receiver operating characteristic curve analyses.  RESULTS: Elevated levels of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, aggregate index of systemic inflammation, modified Glasgow prognostic score, and C-reactive protein were significantly associated with increased exacerbation frequency and hospitalization rates in the overall cohort (all p&lt;0.05), whereas systemic inflammation response index showed no significant association. Receiver operating characteristic analyses demonstrated moderate discriminative ability of C-reactive protein and inflammatory indices for predicting frequent exacerbations.  CONCLUSION: Systemic inflammatory biomarkers were associated with adverse clinical outcomes in patients with chronic obstructive pulmonary disease and were significantly related to exacerbation frequency and severity. These findings suggest that systemic inflammatory markers may be useful for overall clinical assessment and identifying patients at increased risk of exacerbations, rather than for stage-specific risk stratification.<\/jats:p>","DOI":"10.1590\/1806-9282.20251626","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:04:41Z","timestamp":1782137081000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of prognostic biomarkers for exacerbation frequency in patients with chronic obstructive pulmonary disease"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-3844","authenticated-orcid":false,"given":"Gulhan Ayhan","family":"Albayrak","sequence":"first","affiliation":[{"name":"Health Sciences University,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.55891\/wajm.v38i11.25","article-title":"Acute exacerbation of COPD: clinical perspectives and literature review.","volume":"38","author":"Erhabor GE","year":"2021","journal-title":"West Afr J Med"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/resp.14041","article-title":"Chronic obstructive pulmonary disease exacerbation fundamentals: diagnosis, treatment, prevention and disease impact.","volume":"26","author":"MacLeod M","year":"2021","journal-title":"Respirology"},{"issue":"18","key":"ref3","first-page":"5366","article-title":"Systemic inflammation and its impact on the prognosis of patients with chronic obstructive pulmonary disease.","volume":"11","author":"Gogol M","year":"2022","journal-title":"J Clin Med"},{"issue":"11","key":"ref4","first-page":"743","article-title":"The systemic inflammatory response in COPD and its clinical implications.","volume":"57","author":"L\u00f3pez-Campos JL","year":"2021","journal-title":"Arch Bronconeumol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"987","DOI":"10.2147\/COPD.S510118","article-title":"Biomarkers (NLR, PLR, SII) for frequent COPD exacerbations: diagnostic and clinical management implications in a retrospective study.","volume":"20","author":"Fu Y","year":"2025","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"4","key":"ref6","first-page":"1675","article-title":"Evaluation of the systemic inflammatory response index in patients with chronic obstructive pulmonary disease.","volume":"14","author":"Karata\u015f H","year":"2022","journal-title":"J Thorac Dis"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"2839","DOI":"10.2147\/IJGM.S312045","article-title":"Prognostic value of neutrophil:lymphocyte and platelet:lymphocyte ratios for 28-day mortality of patients with AECOPD.","volume":"14","author":"Luo Z","year":"2021","journal-title":"Int J Gen Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.2147\/COPD.S141760","article-title":"Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD.","volume":"12","author":"Yao C","year":"2017","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref9","first-page":"106709","article-title":"Systemic immune-inflammation index as a predictor of clinical outcomes in chronic inflammatory conditions.","volume":"191","author":"Yang YL","year":"2022","journal-title":"Respir Med"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"933","DOI":"10.2147\/COPD.S452444","article-title":"Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers in diagnosis evaluation of acute exacerbation of chronic obstructive pulmonary disease: a retrospective, observational study.","volume":"19","author":"Cai C","year":"2024","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"4","key":"ref11","doi-asserted-by":"crossref","first-page":"2300239","DOI":"10.1183\/13993003.00239-2023","article-title":"Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary.","volume":"61","author":"Agust\u00ed A","year":"2023","journal-title":"Eur Respir J"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2147\/COPD.S447519","article-title":"Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and eosinophil-to-lymphocyte ratio (ELR) as biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).","volume":"19","author":"Liao QQ","year":"2024","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"3","key":"ref13","doi-asserted-by":"crossref","first-page":"152903","DOI":"10.1016\/j.imbio.2025.152903","article-title":"The clinical significance of peripheral blood-related inflammatory markers in patients with AECOPD.","volume":"230","author":"Li D","year":"2025","journal-title":"Immunobiology"},{"issue":"5","key":"ref14","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1080\/17476348.2020.1735366","article-title":"The Glasgow prognostic score can be a predictor of mortality in acute exacerbation of chronic obstructive pulmonary disease.","volume":"14","author":"Kulu\u00f6zt\u00fcrk M","year":"2020","journal-title":"Expert Rev Respir Med"},{"issue":"12","key":"ref15","first-page":"1901","article-title":"Neutrophil-to-lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives.","volume":"58","author":"Paliogiannis P","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"ref16","first-page":"303","article-title":"Systemic immune-inflammation index predicts prognosis in inflammatory diseases.","volume":"14","author":"Hu B","year":"2021","journal-title":"J Inflamm Res"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302026000302207&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:04:43Z","timestamp":1782137083000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302026000302207&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"alternative-id":["S0104-42302026000302207"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20251626","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e20251626"}}