Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis
dc.contributor.author | Mikolasch, TA | |
dc.contributor.author | George, PM | |
dc.contributor.author | Sahota, J | |
dc.contributor.author | Nancarrow, T | |
dc.contributor.author | Barratt, SL | |
dc.contributor.author | Woodhead, FA | |
dc.contributor.author | Kouranos, V | |
dc.contributor.author | Cope, VSA | |
dc.contributor.author | Creamer, AW | |
dc.contributor.author | Fidan, S | |
dc.contributor.author | Ganeshan, B | |
dc.contributor.author | Hoy, L | |
dc.contributor.author | Mackintosh, JA | |
dc.contributor.author | Shortman, R | |
dc.contributor.author | Duckworth, A | |
dc.contributor.author | Fallon, J | |
dc.contributor.author | Garthwaite, H | |
dc.contributor.author | Heightman, M | |
dc.contributor.author | Adamali, HI | |
dc.contributor.author | Lines, S | |
dc.contributor.author | Win, T | |
dc.contributor.author | Wollerton, R | |
dc.contributor.author | Renzoni, EA | |
dc.contributor.author | Steward, M | |
dc.contributor.author | Wells, AU | |
dc.contributor.author | Gibbons, M | |
dc.contributor.author | Groves, AM | |
dc.contributor.author | Gooptu, B | |
dc.contributor.author | Scotton, CJ | |
dc.contributor.author | Porter, JC | |
dc.date.accessioned | 2023-07-13T09:04:07Z | |
dc.date.issued | 2022-12-01 | |
dc.date.updated | 2023-07-13T08:41:41Z | |
dc.description.abstract | 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. | en_GB |
dc.description.sponsorship | Breathing Matters | en_GB |
dc.description.sponsorship | Cystic Fibrosis Trust | en_GB |
dc.description.sponsorship | British Lung Foundation | en_GB |
dc.description.sponsorship | Medical Research Council (MRC) | en_GB |
dc.description.sponsorship | National Institute for Health and Care Research (NIHR) | en_GB |
dc.description.sponsorship | Alpha-1 Foundation | en_GB |
dc.identifier.citation | Vol. 55, article 101758 | en_GB |
dc.identifier.doi | https://doi.org/10.1016/j.eclinm.2022.101758 | |
dc.identifier.grantnumber | SS19/06 | en_GB |
dc.identifier.grantnumber | SS19/06 | en_GB |
dc.identifier.grantnumber | MR/K004158/1 | en_GB |
dc.identifier.grantnumber | MR/N0137941/1 | en_GB |
dc.identifier.grantnumber | MR/V002538/1 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/133592 | |
dc.identifier | ORCID: 0000-0002-9671-9057 (Scotton, Chris J) | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/36483266 | en_GB |
dc.rights | © 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) | en_GB |
dc.subject | Biomarker | en_GB |
dc.subject | ILD | en_GB |
dc.subject | IPF | en_GB |
dc.subject | Interstitial Lung Disease | en_GB |
dc.subject | Leukocyte | en_GB |
dc.subject | Mortality | en_GB |
dc.title | Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2023-07-13T09:04:07Z | |
dc.identifier.issn | 2589-5370 | |
exeter.article-number | 101758 | |
exeter.place-of-publication | England | |
dc.description | This is the final version. Available on open access from Elsevier via the DOI in this record | en_GB |
dc.description | Data sharing statement: Data collected for the study may be accessed after approval of a proposal and with a signed data access agreement with the individual investigators that manage the patient databases. | en_GB |
dc.identifier.eissn | 2589-5370 | |
dc.identifier.journal | EClinicalMedicine | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2022-11-04 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2022-12-01 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2023-07-13T08:59:09Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2023-07-13T09:05:17Z | |
refterms.panel | A | en_GB |
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