Potential of the Advanced Lung Cancer Inflammation Index as a Risk Marker for Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome and COPD: Evidence from NHANES 2007-2018

Nanxin Chen,1 Yuxia Liu,2 Qi Wang,2 Min Wang,2 Jun Wang,2 Wenjing Chen2 1Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250001, People’s Republic of ChinaCorrespondence: Wenjing Chen, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250001, People’s Republic of China, Email [email protected]: The Advanced Lung Cancer Inflammation Index (ALI) is widely recognized as an emerging metric for assessing both inflammation and nutritional levels. However, it is unclear whether there is a correlation between ALI and Asthma-Chronic Obstructive Pulmonary Disease Overlap (ACO), Chronic Obstructive Pulmonary Disease (COPD), and asthma.Materials and Methods: ALI was considered as a continuous and categorical variable (Q1, Q2, Q3, Q4), respectively, and the categories of its categorical variables were based on the quartiles of ALI. Logistic regression models were then developed to analyze the correlation between ALI and ACO, COPD, and asthma. Finally, correlations were further analyzed by propensity score matching (PSM) methods. In addition, we calculated the area under the curve (AUC) of the ROC curve to assess the predictive performance of the ALI.Results: Results with ALI as a continuous variable: ALI was negatively associated with both ACO and COPD (ACO: OR=0.70; 95% CI: 0.58– 0.86; P< 0.001; COPD: OR=0.72; 95% CI: 0.65– 0.79; P< 0.001), whereas there was no association between ALI and asthma (OR=1.08; 95% CI: 0.97– 1.20; P=0.140). Results of ALI as a categorical variable: the negative ALI-ACO association persisted in Q4 groups (Q4: OR=0.66; 95% CI: 0.49– 0.88; P=0.006); the negative ALI-COPD association was maintained in all groups. After PSM, ALI remained negatively associated with ACO and COPD (ACO: OR=0.61; 95% CI: 0.45– 0.83; P=0.002; COPD: OR=0.56; 95% CI: 0.48– 0.64; P< 0.001). The AUC was 0.69 for ALI-ACO and 0.73 for ALI-COPD.Conclusion: High levels of ALI may be associated with a reduced risk of ACO and COPD.Keywords: asthma-COPD overlap syndrome, asthma, COPD, nutrient, inflammation