Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis
Rationale Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease. Patients present at different stages and disease course is varied. Blood monocytes have been linked to all-cause mortality, and neutrophils to progression to IPF in patients with the indeterminate for usual interst...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-02-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/9/1/e001202.full |
| _version_ | 1797777567211585536 |
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| author | Ling-Pei Ho Rosie Barker Harriet Bothwell Andrea Pereira Rachel K Hoyles Rachel Benamore Kritica Dwivedi Andrew Achaiah Amila Rathnapala Valentina Iotchkova |
| author_facet | Ling-Pei Ho Rosie Barker Harriet Bothwell Andrea Pereira Rachel K Hoyles Rachel Benamore Kritica Dwivedi Andrew Achaiah Amila Rathnapala Valentina Iotchkova |
| author_sort | Ling-Pei Ho |
| collection | DOAJ |
| description | Rationale Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease. Patients present at different stages and disease course is varied. Blood monocytes have been linked to all-cause mortality, and neutrophils to progression to IPF in patients with the indeterminate for usual interstitial pneumonia CT pattern.Objective To determine association between blood monocytes, neutrophils and lymphocytes levels (and their derived indexes), with lung function decline and mortality in IPF.Methods We performed a retrospective analysis of an IPF cohort (n=128) who had their first clinical visit at the Oxford Interstitial Lung Disease Service between 2013 and 2017. Association between blood monocytes, neutrophils, lymphocytes and derived indexes (within 4 months of visit) and decline in forced vital capacity (FVC) and all-cause mortality were assessed using Cox proportional hazard regression analysis. Kaplan-Meier analysis was used to assess time-to-event for 10% FVC decline and mortality for patients dichotomised to high and low leucocyte counts.Results Median length of follow-up was 31.0 months (IQR 16.2–42.4); 41.4% demonstrated FVC decline >10% per year and 43.8% died. In multivariate models (incorporating age, gender and initial FVC%), raised neutrophils, lymphopaenia and neutrophil:lymphocyte ratio were associated with FVC decline (p≤0.01); while both monocytes and neutrophil levels (and their derived indexes) were associated with all-cause mortality (p≤0.01). Kaplan-Meier analysis also showed association between neutrophils and its derived indexes but not monocyte, with FVC decline.Conclusion Blood neutrophil and lymphopaenia are more sensitive than monocytes as prognostic indicators of disease progression in those with established IPF. |
| first_indexed | 2024-03-12T23:05:46Z |
| format | Article |
| id | doaj.art-84320416701d4b0594b9a41ecaa34f6a |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-12T23:05:46Z |
| publishDate | 2022-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-84320416701d4b0594b9a41ecaa34f6a2023-07-18T20:30:06ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392022-02-019110.1136/bmjresp-2022-001202Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary FibrosisLing-Pei Ho0Rosie Barker1Harriet Bothwell2Andrea Pereira3Rachel K Hoyles4Rachel Benamore5Kritica Dwivedi6Andrew Achaiah7Amila Rathnapala8Valentina Iotchkova9MRC Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UKCentre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UKUndergraduate Education, Great Western Hospitals NHS Foundation Trust, Swindon, UKCentre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UKCentre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UKDepartment of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UKCentre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UKMRC Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UKCentre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UKMRC Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UKRationale Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease. Patients present at different stages and disease course is varied. Blood monocytes have been linked to all-cause mortality, and neutrophils to progression to IPF in patients with the indeterminate for usual interstitial pneumonia CT pattern.Objective To determine association between blood monocytes, neutrophils and lymphocytes levels (and their derived indexes), with lung function decline and mortality in IPF.Methods We performed a retrospective analysis of an IPF cohort (n=128) who had their first clinical visit at the Oxford Interstitial Lung Disease Service between 2013 and 2017. Association between blood monocytes, neutrophils, lymphocytes and derived indexes (within 4 months of visit) and decline in forced vital capacity (FVC) and all-cause mortality were assessed using Cox proportional hazard regression analysis. Kaplan-Meier analysis was used to assess time-to-event for 10% FVC decline and mortality for patients dichotomised to high and low leucocyte counts.Results Median length of follow-up was 31.0 months (IQR 16.2–42.4); 41.4% demonstrated FVC decline >10% per year and 43.8% died. In multivariate models (incorporating age, gender and initial FVC%), raised neutrophils, lymphopaenia and neutrophil:lymphocyte ratio were associated with FVC decline (p≤0.01); while both monocytes and neutrophil levels (and their derived indexes) were associated with all-cause mortality (p≤0.01). Kaplan-Meier analysis also showed association between neutrophils and its derived indexes but not monocyte, with FVC decline.Conclusion Blood neutrophil and lymphopaenia are more sensitive than monocytes as prognostic indicators of disease progression in those with established IPF.https://bmjopenrespres.bmj.com/content/9/1/e001202.full |
| spellingShingle | Ling-Pei Ho Rosie Barker Harriet Bothwell Andrea Pereira Rachel K Hoyles Rachel Benamore Kritica Dwivedi Andrew Achaiah Amila Rathnapala Valentina Iotchkova Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis BMJ Open Respiratory Research |
| title | Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis |
| title_full | Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis |
| title_fullStr | Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis |
| title_full_unstemmed | Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis |
| title_short | Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis |
| title_sort | neutrophil lymphocyte ratio as an indicator for disease progression in idiopathic pulmonary fibrosis |
| url | https://bmjopenrespres.bmj.com/content/9/1/e001202.full |
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