{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:41:44Z","timestamp":1793814104349,"version":"4.6.1"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Bronchiectasis is a heterogeneous chronic inflammatory airway disease characterized by recurrent exacerbations. Data on composite inflammatory biomarkers for assessing disease activity remain limited. Methods: This retrospective study included 97 patients with non-cystic fibrosis bronchiectasis categorized as stable (n = 39) or with exacerbated bronchiectasis (n = 58). Demographic, clinical, and laboratory data were analyzed, and inflammatory indices\u2014NLR (neutrophil\u2013lymphocyte ratio), PLR (platelet\u2013lymphocyte ratio), SII (Systemic Immune-Inflammation Index), PIV (Pan-Immune-Inflammation Value), CAR (C-reactive protein-to-albumin ratio), and HALP score (hemoglobin \u00d7 albumin \u00d7 lymphocyte\/platelet)\u2014were calculated, followed by multivariate logistic regression and ROC analyses. Results: Patients with bronchiectasis exacerbations had a higher NLR, PLR, PIV, SII, and CAR and lower HALP (all p &lt; 0.001). The C-reactive protein-to-albumin ratio demonstrated the highest discriminative ability (AUC = 0.995), followed by SII and NLR, while lower HALP and SII were independent predictors of exacerbation. The C-reactive protein-to-albumin and sedimentation-to-albumin ratios were strongly correlated with hospitalization duration (both p &lt; 0.001). Conclusions: Composite inflammatory indices are strongly associated with disease activity in bronchiectasis. CAR showed excellent discriminative performance, while HALP and SII independently predicted exacerbation. These simple, cost-effective biomarkers may support risk stratification and clinical monitoring in routine practice.<\/jats:p>","DOI":"10.3390\/life16060949","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:37:29Z","timestamp":1780544249000},"page":"949","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Evaluation of Systemic Inflammatory Indices in Bronchiectasis: Identification of Exacerbation Phenotype"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5641-012X","authenticated-orcid":false,"given":"Selda","family":"G\u00fcnayd\u0131n","sequence":"first","affiliation":[{"name":"Department of Chest Diseases, Giresun University Faculty of Medicine, Giresun 28100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4390-5198","authenticated-orcid":false,"given":"Hayriye Bekta\u015f","family":"Aksoy","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Giresun University Faculty of Medicine, Giresun 28100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015eaban Melih","family":"\u015eim\u015fek","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Giresun University Faculty of Medicine, Giresun 28100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.4187\/respcare.05276","article-title":"Serum Albumin and Disease Severity of Non-Cystic Fibrosis Bronchiectasis","volume":"62","author":"Lee","year":"2017","journal-title":"Respir. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230234","DOI":"10.1183\/16000617.0234-2023","article-title":"Biomarkers in bronchiectasis","volume":"33","author":"Johnson","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6675","DOI":"10.3390\/cimb46070398","article-title":"Potential New Inflammatory Markers in Bronchiectasis: A Literature Review","volume":"46","author":"Bertuccio","year":"2024","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_4","first-page":"1","article-title":"British Thoracic Society Guideline for bronchiectasis in adults","volume":"74","author":"Hill","year":"2019","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"240179","DOI":"10.1183\/16000617.0179-2024","article-title":"Neutrophilic inflammation in bronchiectasis","volume":"34","author":"Chalmers","year":"2025","journal-title":"Eur. Respir. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"210119","DOI":"10.1183\/20734735.0119-2021","article-title":"Precision medicine in bronchiectasis","volume":"17","author":"Pembridge","year":"2021","journal-title":"Breathe"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Menendez, R., Mendez, R., Amara-Elori, I., Reyes, S., Montull, B., Feced, L., Alonso, R., Amaro, R., Alcaraz, V., and Fernandez-Barat, L. (2020). Systemic Inflammation during and after Bronchiectasis Exacerbations: Impact of Pseudomonas aeruginosa. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082631"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1186\/s40001-025-03090-5","article-title":"Roles of C-reactive protein and its composite index in predicting acute exacerbation of bronchiectasis","volume":"30","author":"Zhang","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3889","DOI":"10.37358\/RC.19.11.7665","article-title":"Neutrophil-to-lymphocyte ratio (NLR) and Platelets-to-lymphocyte (PLR) Ratio in Patients with Exacerbation of Bronchiectasis","volume":"70","author":"Motoc","year":"2019","journal-title":"Rev. Chim."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2372901","DOI":"10.1080\/20018525.2024.2372901","article-title":"Baseline neutrophil-to-lymphocyte ratio as a predictor of response to hospitalized bronchiectasis exacerbation risks","volume":"11","author":"Kwok","year":"2024","journal-title":"Eur. Clin. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6051","DOI":"10.2147\/JIR.S479214","article-title":"The association between systemic immune-inflammation index at admission and readmission in patients with bronchiectasis","volume":"17","author":"Gao","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_12","first-page":"16003","article-title":"Prognostic significance of HALP score in Idiopathic Pulmonary Fibrosis-related mortality","volume":"42","author":"Colak","year":"2025","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"500","DOI":"10.35440\/hutfd.1670689","article-title":"HALP Skorunun Koroner Arter Hastal\u0131\u011f\u0131n\u0131n \u015eiddetini \u00d6ng\u00f6rmedeki De\u011feri","volume":"22","year":"2025","journal-title":"Harran \u00dcniv. T\u0131p Fak. Derg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2501126","DOI":"10.1183\/13993003.01126-2025","article-title":"European Respiratory Society clinical practice guideline for the management of adult bronchiectasis","volume":"66","author":"Chalmers","year":"2025","journal-title":"Eur. Respir. J."},{"key":"ref_15","first-page":"202401811","article-title":"Could the HALP score serve as a biomarker of bronchiectasis exacerbation?","volume":"72","author":"Erel","year":"2024","journal-title":"Tuberc. Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"976","DOI":"10.21037\/atm-21-2120","article-title":"Predictive value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and lymphocyte-to-monocyte ratio (LMR) in patients with non-small cell lung cancer after radical lung cancer surgery","volume":"9","author":"Zhai","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, Q., Chen, M., Zhao, H., and Zeng, J. (2025). The prognostic and clinicopathological value of HALP score in non-small cell lung cancer. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1576326"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"153","DOI":"10.18632\/oncotarget.28367","article-title":"What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP\u2019s prognostic ability in different cancer types","volume":"14","author":"Farag","year":"2023","journal-title":"Oncotarget"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ranzani, O.T., Zampieri, F.G., Forte, D.N., Azevedo, L.C., and Park, M. (2013). C-reactive protein\/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0059321"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8835","DOI":"10.18632\/oncotarget.13053","article-title":"The C-reactive protein\/albumin ratio predicts long-term outcomes of patients with operable non-small cell lung cancer","volume":"8","author":"Zhang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Xu, X.L., Yu, H.Q., Hu, W., Song, Q., and Mao, W.M. (2015). A Novel Inflammation-Based Prognostic Score, the C-Reactive Protein\/Albumin Ratio Predicts the Prognosis of Patients with Operable Esophageal Squamous Cell Carcinoma. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138657"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wei, X.L., Wang, F.H., Zhang, D.S., Qiu, M.Z., Ren, C., Jin, Y., Zhou, Y.X., Wang, D.S., He, M.M., and Bai, L. (2015). A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: The C-reactive protein\/albumin ratio. BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1379-6"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.7150\/jca.16210","article-title":"The C-reactive Protein\/Albumin Ratio Is an independent Prognostic Factor for Overall Survival in Patients with Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy","volume":"7","author":"Tao","year":"2016","journal-title":"J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.7150\/jca.16443","article-title":"C-Reactive Protein\/Albumin Ratio (CAR) as a Prognostic Factor in Patients with Non-Metastatic Nasopharyngeal Carcinoma","volume":"7","author":"He","year":"2016","journal-title":"J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1111\/IGC.0b013e3181e64bb1","article-title":"The inflammation-based Glasgow Prognostic Score predicts survival in patients with cervical cancer","volume":"20","author":"Polterauer","year":"2010","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"796","DOI":"10.21470\/1678-9741-2020-0269","article-title":"Glasgow prognostic score as a marker of mortality after TAVI","volume":"36","author":"Abacioglu","year":"2021","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s00408-024-00707-0","article-title":"Type 2 biomarkers and their clinical implications in bronchiectasis: A prospective cohort study","volume":"202","author":"Chen","year":"2024","journal-title":"Lung"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1164\/rccm.201309-1575OC","article-title":"The bronchiectasis severity index. An international derivation and validation study","volume":"189","author":"Chalmers","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1183\/09031936.00026313","article-title":"Multidimensional approach to non-cystic fibrosis bronchiectasis: The FACED score","volume":"43","author":"Giron","year":"2014","journal-title":"Eur. Respir. J."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/949\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:16:23Z","timestamp":1780546583000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/949"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["life16060949"],"URL":"https:\/\/doi.org\/10.3390\/life16060949","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}