Sarcopenia, Eosinophil-to-Platelet Ratio, and C-Reactive Protein as Predictors of Adverse Occupational Health Outcomes in Workers with Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) affects many industrial workers and can lead to absenteeism, disability, and other adverse occupational outcomes. Identifying biomarkers that predict poorer work-related prognosis in COPD could help target workplace accommodations and interventions. This study evaluated whether sarcopenia, eosinophil-to-platelet ratio (EPR), and C-reactive protein (CRP) levels predicted adverse occupational health outcomes, such as missed workdays, job loss, and work disability in workers with COPD exacerbations.

Methods: This prospective cohort study enrolled 200 working-age adults (18-65 years) with COPD who were employed at the time of an acute exacerbation requiring hospitalization. Sarcopenia, EPR, CRP, and other clinical characteristics were assessed at baseline. Participants were followed for 12 months to ascertain adverse occupational outcomes, including absenteeism (>14 days of missed work), employment termination, and application for disability benefits. Regression analysis determined biomarker associations with occupational outcomes.

Results: Over 12 months, 22% of participants experienced prolonged absenteeism, 11% lost employment, and 9% applied for disability. After adjustment, low EPR (OR 2.81, 95% CI 1.23-6.41) and high CRP (OR 2.67, 95% CI 1.19-5.99) were associated with absenteeism. Only EPR (OR 3.25, 95% CI 1.07-9.88) predicted employment loss. Both low EPR (OR 4.12, 95% CI 1.41-11.98) and high CRP (OR 2.93, 95% CI 1.02-8.38) increased the odds of disability application. Sarcopenia was not significantly associated with the occupational outcomes after controlling for covariates.

Conclusion: Among working adults with COPD, low EPR and high CRP levels were robust predictors of prolonged absenteeism, job termination, and disability application following exacerbations. Assessing these inflammatory biomarkers could identify workers at elevated risk of poor occupational trajectories who may benefit from targeted workplace accommodations, rehabilitation programs, or other interventions to preserve employment.