PT - JOURNAL ARTICLE AU - Achaiah, Andrew AU - Rathnapala, Amila AU - Pereira, Andrea AU - Bothwell, Harriet AU - Dwivedi, Kritica AU - Barker, Rosie AU - Iotchkova, Valentina AU - Benamore, Rachel AU - Hoyles, Rachel K AU - Ho, Ling-Pei TI - Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis AID - 10.1136/bmjresp-2022-001202 DP - 2022 Jun 01 TA - BMJ Open Respiratory Research PG - e001202 VI - 9 IP - 1 4099 - http://bmjopenrespres.bmj.com/content/9/1/e001202.short 4100 - http://bmjopenrespres.bmj.com/content/9/1/e001202.full SO - BMJ Open Resp Res2022 Jun 01; 9 AB - 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.All data relevant to the study are included in the article or uploaded as online supplemental information.