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  • Use of peripheral neutrophil to lymphocyte ratio and peripheral monocyte levels to predict survival in fibrotic hypersensitivity pneumonitis (fHP): a multicentre retrospective cohort study

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Interstitial lung disease
Use of peripheral neutrophil to lymphocyte ratio and peripheral monocyte levels to predict survival in fibrotic hypersensitivity pneumonitis (fHP): a multicentre retrospective cohort study
  1. Shaney L Barratt1,
  2. Andrew W Creamer1,
  3. Huzaifa I Adamali1,
  4. Anna Duckworth2,
  5. Janet Fallon3,
  6. Silan Fidan4,
  7. Tom Nancarrow5,
  8. Rebecca Wollerton5,
  9. Matthew Steward5,
  10. Bibek Gooptu6,
  11. Michael Gibbons7,
  12. Felix Alexander Woodhead4 and
  13. Chris Scotton2
  1. 1Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
  2. 2Institute of Biomedical and Clinical Sciences, University of Exeter, Exeter, UK
  3. 3Department of Respiratory Medicine, Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK
  4. 4Department of Respiratory Medicine, Institute for Lung Health, Leicester, UK
  5. 5Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
  6. 6University of Leicester, Leicester, Leicestershire, UK
  7. 7Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, Devon, UK
  1. Correspondence to Dr Shaney L Barratt; mdzslb{at}bristol.ac.uk

Abstract

The factors determining disease course and survival in fibrotic hypersensitivity pneumonitis (fHP) have not been fully elucidated.

The aim of this study was to describe the characteristics of patients with fHP in a real-world cohort and investigate factors associated with worse outcomes. We aimed to explore the use of neutrophil to lymphocyte ratio (NLR) and peripheral blood monocyte levels in predicting mortality.

Methods A retrospective, multicentre, observational UK cohort study.

Results Patients with fHP were significantly younger than those with idiopathic pulmonary fibrosis (IPF) (median age fHP 73 vs IPF 75 years) and were much more likely to be woman (fHP 61% vs IPF 26%). In almost half of all fHP cases (49%, n=104/211), no causative antigen was identified from either the history or specific antigen testing. Overall, fHP was associated with a better survival than IPF, although median survival of both groups was poor (fHP 62 months vs IPF 52 months).

IPF survival in patients with a high NLR was significantly lower than those with a low NLR (44 vs 83 months). A monocyte count ≥0.95 K/uL also predicted significantly poorer outcomes for patients with IPF compared with <0.95 K/uL (33 vs 57 months). In contrast, NLR and monocyte count did not predict survival in the fHP cohort.

Conclusions Although fHP has a statistically lower mortality than IPF, absolute survival time of both conditions is poor. High baseline NLR and absolute monocyte counts predict worse survival in IPF but not in fHP, highlighting the potential for divergence in their pathogenic mechanisms.

  • lymphocyte biology
  • interstitial fibrosis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2021-001063

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • Contributors FAW, MG, CS, SLB conceived the project idea. SLB wrote the research protocol and sought regulatory approval. SLB and CS wrote the first draft of the manuscript. HIA, AWC, AD, JF, SF, TN, RW facilitated data collection. All authors (FAW, MG, CS, SLB, HIA, AWC, AD, JF, SF, TN, RW, MS) contributed to the final draft of the manuscript. SLB was the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SLB has received honoraria from Boehringer Ingelheim for consultancy work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.