Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis.

Autor:	Mikolasch TA; CITR, UCL Respiratory, UCL, London, UK.; Interstitial Lung Disease Service, UCLH NHS Trust, London, UK., George PM; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK.; National Heart and Lung Institute, Imperial College London, UK., Sahota J; CITR, UCL Respiratory, UCL, London, UK.; Interstitial Lung Disease Service, UCLH NHS Trust, London, UK., Nancarrow T; College of Medicine & Health, University of Exeter, Exeter, UK.; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Barratt SL; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.; Academic Respiratory Unit, University of Bristol, Bristol, UK., Woodhead FA; Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK.; Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK., Kouranos V; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK.; National Heart and Lung Institute, Imperial College London, UK., Cope VSA; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK., Creamer AW; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.; Academic Respiratory Unit, University of Bristol, Bristol, UK., Fidan S; Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK.; Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK., Ganeshan B; Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK., Hoy L; Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK., Mackintosh JA; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK.; The Prince Charles Hospital, Queensland, Australia., Shortman R; Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK., Duckworth A; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Fallon J; Department of Respiratory Medicine, Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK., Garthwaite H; Interstitial Lung Disease Service, UCLH NHS Trust, London, UK., Heightman M; Interstitial Lung Disease Service, UCLH NHS Trust, London, UK., Adamali HI; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.; Academic Respiratory Unit, University of Bristol, Bristol, UK., Lines S; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Win T; Lister Hospital, North East Herts Trust, Stevenage UK., Wollerton R; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Renzoni EA; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK.; National Heart and Lung Institute, Imperial College London, UK., Steward M; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Wells AU; Interstitial Lung Disease Unit, Royal Brompton Hospital, UK.; National Heart and Lung Institute, Imperial College London, UK., Gibbons M; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Groves AM; Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK., Gooptu B; Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK.; Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK., Scotton CJ; College of Medicine & Health, University of Exeter, Exeter, UK.; Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK., Porter JC; CITR, UCL Respiratory, UCL, London, UK.; Interstitial Lung Disease Service, UCLH NHS Trust, London, UK.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2022 Dec 01; Vol. 55, pp. 101758. Date of Electronic Publication: 2022 Dec 01 (Print Publication: 2023).
DOI:	10.1016/j.eclinm.2022.101758
Abstrakt:	Background: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease trajectory. The aim of this study was to assess the potential of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in IPF. Methods: We adopted a two-stage discovery (n = 71) and validation (n = 134) design using patients from the UCL partners (UCLp) cohort. We then combined discovery and validation cohorts and included an additional 794 people with IPF, using real-life data from 5 other UK centers, to give a combined cohort of 999 patients. Data were collected from patients presenting over a 13-year period (2006-2019) with mean follow up of 3.7 years (censoring: 2018-2020). Findings: In the discovery analysis, we showed that high values of NLR (>/ = 2.9 vs < 2.9) were associated with increased risk of mortality in IPF (HR 2.04, 95% CI 1.09-3.81, n = 71, p = 0.025). This was confirmed in the validation (HR 1.91, 95% CI 1.15-3.18, n = 134, p = 0.0114) and combined cohorts (HR 1.65, n = 999, 95% CI 1.39-1.95; p < 0·0001). NLR correlated with GAP stage and GAP index (p < 0.0001). Stratifying patients by NLR category (low/high) showed significant differences in survival for GAP stage 2 (p < 0.0001), however not for GAP stage 1 or 3. In a multivariate analysis, a high NLR was an independent predictor of mortality/progression after adjustment for individual GAP components and steroid/anti-fibrotic use (p < 0·03). Furthermore, incorporation of baseline NLR in a modified GAP-stage/index, GAP-index/stage-plus, refined prognostic ability as measured by concordance (C)-index. Interpretation: We have identified NLR as a widely available test that significantly correlates with lung function, can predict outcomes in IPF and refines cohort staging with GAP. NLR may allow timely prioritisation of at-risk patients, even in the absence of lung function. Funding: Breathing Matters, GSK, CF Trust, BLF-Asthma, MRC, NIHR Alpha-1 Foundation. Competing Interests: SLB reports consultancy fees from Boehringer Ingelheim (BI). PMG reports personal fees from BI and AstraZeneca (AZ) and Brainomix and lecturing honoraria from BI, Roche and Cipla. VK reports lecturing fees from Novartis, Roche, and BI. JCP reports consulting fees from Carrick therapeutics, AZ and lecturing honaria from The Limbic. EAR reports lecturing fees from BI and Mundipharma. SL reports conference attendance support from BI. AUW reports honoraria from BI and Roche and consulting fees from Roche, BI and Veracyte. FAW reports support for conference attendance from BI. FW is now a full-time employee of Avalyn Pharma Inc, but all work related to this manuscript was carried out whilst a fulltime NHS employee of the University Hospitals of Leicester NHS Trust. All other authors have nothing to disclose. (© 2022 The Authors.)
Databáze:	MEDLINE
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