Inflammatory Markers in Patients with Chronic Respiratory Failure: C-reactive Protein, Procalcitonin, Neutrophil/Lymphocyte ratio in Acute and Chronic State of Pulmonary Diseases

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Background

Patients with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, interstitial lung diseases (sarcoidosis, idiopathic pulmonary fibrosis), obesity hypoventilation, and kyphoscoliosis need close follow up for preventing hospitalization due to acute exacerbation of chronic underlying diseases. Among these patient groups, close follow-up and prevention of hospitalization and emergency department admission are very important for the patients receiving long-term oxygen therapy (LTOT) and home non-invasive mechanical ventilation (H-NIMV). These patients generally admitted to the hospital for infectious events with deterioration of already limited health conditions. Early recognition of any infectious event leads to initiate early treatment which prevents hospital admission.

Recently, well-known inflammatory markers, such as white blood cell count and neutrophile to lymphocyte ratio (NLR ) obtained from whole blood count can be easily used in daily clinical practice. The acute exacerbation of underlying chronic respiratory diseases could be easily recognized by these inflammatory markers if previously examined by the clinicians in routine follow-up. The higher values of inflammatory markers can help the physicians distinguishing the acute exacerbation or infectious events. However, if the values of the inflammatory markers are slightly higher, further tests are needed for the diagnosis.
Through the broad spectrum of chronic pulmonary diseases, each inflammatory markers behave independently. Single measurements of those tests are not helpful for differential diagnosis, especially if the values of the inflammatory markers are slightly higher. Patients' previous inflammatory marker values would be essential for the current diagnosis. Various chronic respiratory diseases can affect the inflammatory markers differently and also each patient's inflammatory responses can be different. Nowadays, personalized treatment is a novel and well-established approach, and really important for the management of the patient with chronic respiratory diseases.

The decision of the need for antibiotic treatment is another challenging issue for physicians in daily clinical practice. Overtreatment is a frequent problem all over the world. Procalcitonin can be helpful to physicians during the follow-up period. However, procalcitonin and c-reactive protein values are not available in the emergency department and also in the out-patients clinic.
Meanwhile, whole blood count could easily be measured and available in every department in the hospital. Further evidence and studies are still needed to demonstrate the importance and the utility of the inflammatory markers especially for NLR, among the patients with acute exacerbation of chronic respiratory diseases.

Welcome topics include but are not limited to the following:

• Studies which help discover the cut-off values of inflammatory markers for different pulmonary diseases.
• Patients' serial inflammatory marker data during follow-up that can help the physicians for current clinical status.
• studies on biomarkers of COPD
• Biomarkers of Asthma
• Biomarkers of Sarcoidosis
• Biomarkers of interstitial lung diseases
• Biomarkers of kyphoscoliosis
• Biomarkers in obesity hypoventilation
• Intellectual Health control system and automatic calculations of NLR, C-reactive protein, or procalcitonin values with patients' electronic historical data for initiating antibiotic treatment.
• cross-reaction with Covid-19 infection

Also, studies on new approaches and novel biomarkers for diagnosis and follow-up to the treatment of chronic lung diseases will be particularly welcome in this Research Topic.
For example, the neutrophil and lymphocyte count ratio (NLR), the mean platelet count to platelet count ratio (MPV/PLT), and the platelet and lymphocyte count ratios (PLR) that are obtained from complete blood count are novel inflammatory biomarkers that can be used for the definition of acute exacerbations of pulmonary diseases and in the treatment response.
Identification of novel biomarkers that have value in the definition of acute and chronic airway diseases (COPD, asthma) and pulmonary diseases (pneumonia including COVID-19 and interstitial lung diseases) will be important topics in this collection.

Keywords: respiratory failure, chronic respiratory diseases, pneumonia, covid-19, inflammatory markers, neutrophil to lymphocyte ratio, procalcitonin, C-reactive protein

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