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ORIGINAL ARTICLE   

Minerva Medica 2022 June;113(3):526-31

DOI: 10.23736/S0026-4806.20.06614-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Neutrophil-to-lymphocyte ratio in bronchoalveolar lavage from IPF patients: a novel prognostic biomarker?

Miriana D’ALESSANDRO 1 , Laura BERGANTINI 1, Alfonso CARLEO 2, Paolo CAMELI 1, Anna PERRONE 1, Antonella FOSSI 1, Piersante SESTINI 1, Elena BARGAGLI 1

1 Unit of Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, University Hospital of Siena, Siena, Italy; 2 Hannover Medical School, Department of Pulmonology, Hannover, Germany



BACKGROUND: THIS is the first time that a bronchoalveolar lavage (BAL) neutrophil-to-lymphocyte ratio (NL-ratio) has been demonstrated in sarcoidosis and chronic hypersensitivity pneumonitis (cHP) than in idiopathic pulmonary fibrosis (IPF) patients.
METHODS: Consecutive BAL samples from the 167 interstitial lung disease (ILD) patients were retrospectively enrolled in the study and clustered into three diagnostic categories: IPF, cHP and sarcoidosis.
RESULTS: NL-ratio which proved higher in IPF (mean±SD, 2.1±3.8) than sarcoidosis (mean±SD 0.7±1.9; P<1E-04) and cHP patients (mean±SD 1.6±3.1; P=7.7E-03). ROC curve analysis to discriminate between Sarcoidosis and other ILDs showed an area under the curve (AUC) of 83.7%, (56% sensitivity and 96% specificity) while IPF and the other ILD were discriminated with AUC of 73% using a NL-ratio threshold value of 0.48 (73% sensitivity and 63% specificity). Interestingly, the NL-ratio was significantly correlated with other prognostic parameters: it was inversely correlated with forced vital capacity (FVC) (r=-0.3; P=2.5E-02) and forced expiration volume in 1 second (FEV1) (r=-0.3; P=2E-02) percentages and directly correlated with composite pulmonary index (CPI) score (r=0.3; P=3.2E-02). A decision-tree statistical algorithm was applied.
CONCLUSIONS: This is the first time that a lower NL-ratio has been demonstrated in sarcoidosis and cHP than in IPF patients. The present preliminary report indicates a relationship between BAL NL-ratio and lung function parameters in patients with IPF: this ratio may help to optimize management of IPF patients and to improve follow-up and outcome.


KEY WORDS: NeutrophilS; Lymphocytes; Sarcoidosis; Alveolitis, extrinsic allergic; Idiopathic pulmonary fibrosis; Lung diseases, interstitial

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