Abstract
PurposeTo evaluate the association of peripheral blood (PBL) and broncho-alveolar lavage (BAL) biomarkers with inflammatory versus fibrotic high-resolution computed tomography (HRCT) findings in interstitial lung disease (ILD) patients.MethodsHRCT findings of 127 consecutive ILD-board patients were semi-quantitatively evaluated: reticulation/honeycombing (RET), traction bronchiectasis (TBR) and emphysema (EMP) were classified as non-inflammatory/fibrotic; consolidations (CON), ground glass opacities (GGO), parenchymal nodules (NDL) and mosaic attenuation (MOS) as active inflammatory. Each HRCT finding was assessed in six distinct lung regions, resulting scores were graded as minimal (0–1 regions involved), medium (2–4) or extensive (5–6). Associations of routinely assessed PBL/BAL biomarkers with these HRCT scores were evaluated using Spearman correlation coefficients and graphical presentation; significance was tested by applying Kruskal–Wallis tests.ResultsBlood neutrophil, lymphocyte and eosinophil fraction, neutrophil to lymphocyte ratio (NLR) and BAL lymphocyte fraction consistently showed opposite correlations with inflammatory versus non-inflammatory/fibrotic HRCT finding scores. Blood lymphocyte fraction significantly differed by graded GGO (p = 0.032) and CON (p = 0.027) extent, eosinophil fraction by TBR (p = 0.006) and NLR by CON (p = 0.009). C-reactive protein was significantly related to GGO (p = 0.023) and CON (p = 0.004), BAL lymphocyte fraction to GGO (p = 0.017) extent.ConclusionBlood lymphocyte and eosinophil fraction, NLR, CRP and BAL lymphocyte fraction may aid to differentiate inflammatory from non-inflammatory/fibrotic ILD patterns.Trial registrationThis evaluation was based on data from the ILD registry of Kepler University Hospital Linz, as approved by the ethics committee of the Federal State of Upper-Austria (EK Number. I-26-17).
Highlights
The anti-fibrotic drugs pirfenidone and nintedanib decelerate lung function decline in idiopathic pulmonary fibrosis (IPF) and progressive fibrosing interstitial lung diseases (PFILD) [1,2,3,4], while patients with ILD susceptible to immunomodulatory therapies can experience an improvement in both radiological imaging and pulmonary function
high-resolution computed tomography (HRCT), peripheral blood (PBL) and broncho-alveolar lavage (BAL) characteristics according to ILDboard diagnoses are shown in Supplementary Table 1
Our analyses indicate that PBL lymphocyte and eosinophil fraction, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) as well as BAL lymphocyte fraction may have clinically relevant implications in differing HRCT abnormalities indicating either active inflammation or non-inflammatory/fibrotic processes
Summary
The anti-fibrotic drugs pirfenidone and nintedanib decelerate lung function decline in idiopathic pulmonary fibrosis (IPF) and progressive fibrosing interstitial lung diseases (PFILD) [1,2,3,4], while patients with ILD susceptible to immunomodulatory therapies can experience an improvement in both radiological imaging and pulmonary functionExtended author information available on the last page of the article tests [5,6,7]. The anti-fibrotic drugs pirfenidone and nintedanib decelerate lung function decline in idiopathic pulmonary fibrosis (IPF) and progressive fibrosing interstitial lung diseases (PFILD) [1,2,3,4], while patients with ILD susceptible to immunomodulatory therapies can experience an improvement in both radiological imaging and pulmonary function. A combination of prednisone, azathioprine and N-acetylcysteine led to adverse outcomes in IPF patients [10, 11], while in SSCILD placebo-controlled trials have provided evidence on the efficacy of immunosuppressive as well as anti-fibrotic therapies [6, 12, 13]. In most ILD cases, HRCT patterns are not uniform but rather involve several coexisting abnormalities for example reticulation (RET), ground glass opacities (GGO) and traction bronchiectasis (TBR) in fibrotic NSIP. The relative distribution and extent of such radiological findings depends on the underlying pathogenetic processes, the course and duration of disease [15]
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