The Role of Advanced Lung Cancer Inflammation Index in Predicting COPD Exacerbation Risks

Wang Chun Kwok,1 Sze Him Isaac Leung,2 Terence Chi Chun Tam,1 Chi Hung Chau,3 Fai Man Lam,3 James Chung Man Ho1 1Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, People’s Republic of China; 2Department of Statistics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China; 3Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong SAR, People’s Republic of ChinaCorrespondence: James Chung Man Ho, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, People’s Republic of China, Email jhocm@hku.hkBackground: The role of the Advanced Lung Cancer Inflammation Index (ALI) in chronic obstructive pulmonary disease (COPD) remains unclear, although it has been utilized to investigate various non-malignant conditions.Methods: A prospective study involving Chinese patients with COPD was carried out in Hong Kong to examine the relationship between baseline ALI levels and the risk of acute exacerbations of COPD (AECOPD). ALI was evaluated across quartiles. Patients were prospectively recruited from respiratory clinic in Queen Mary Hospital and Grantham Hospital in 2021, follow up with patients was done until 8th March 2025 or the death date, whichever is earlier.Results: Among 272 Chinese COPD patients recruited, 138 of them had moderate to severe AECOPD and 66 patients died in the follow-up period. Those in the Q1 ALI, when compared with Q4 (highest quartile), had significantly shorter time to moderate to severe AECOPD with adjusted hazard ratio of (aHR) 2.17 (95% CI = 1.29– 3.65, p = 0.011), severe AECOPD (aHR 2.05, 95% CI = 1.18– 3.55, p = 0.011) and overall survival (aHR 2.73, 95% CI = 1.21– 6.15, p = 0.015). The same phenomenon was also observed in the patient subgroup with baseline blood eosinophil counts < 300 cells/μL.Conclusion: In this prospective study, it suggested that ALI can serve as a biomarker to predict the risk of moderate to severe AECOPD, as well as severe AECOPD and mortality. The phenomenon was also observed in the non-eosinophilic subgroup. This can allow clinicians to use this simple and repeatable biomarker as a way to prognosticate COPD patients and estimate AECOPD risks.Keywords: COPD, COPD exacerbation, advanced lung cancer inflammation index, biomarkers