Antifibrotic therapy is widely used for patients with progressive fibrotic interstitial lung disease (ILD), regardless of etiology. There is an urgent need for a simple, inexpensive, and repeatable biomarker to evaluate disease severity and mortality risk. This retrospective multicohort study assessed the neutrophil–lymphocyte ratios (NLRs) of 416 patients with ILD who received antifibrotic therapy (Hamamatsu cohort, n = 217; Seirei cohort, n = 199). The mortality risk vs. NLR relationship was evaluated at therapy initiation and 1 year. The optimal NLR cutoff of 2.7 was selected according to the mortality risk. Survival was shorter in patients with high NLR than with low NLR (median: 2.63 vs. 4.01 years). The NLR classification results (cutoff: 2.7) were longitudinally preserved in >70 % of the patients, and patients with consistently high NLR had a higher risk of mortality than others (median, 2.97 vs. 4.42 years). In multivariate analysis, high NLR was significantly associated with mortality independent of age, sex, forced vital capacity, lung diffusing capacity for carbon monoxide (D), or the gender–age–physiology (GAP) index. A combined GAP index–NLR assessment classified mortality risk into four groups. Subset analyses revealed that NLR assessment was more applicable to patients without advanced disease, not taking steroids, and with idiopathic pulmonary fibrosis (IPF) than to patients with advanced disease, taking steroids, and patients with Non-IPF. High NLR was associated with an increased mortality risk in patients with ILDs receiving antifibrotic therapy. Assessment of NLR may help predict disease severity and mortality risk in antifibrotic therapy.

中文翻译：

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中性粒细胞-淋巴细胞比率与接受抗纤维化治疗的患者的死亡风险相关

无论病因如何，抗纤维化治疗广泛用于患有进行性纤维化间质性肺病 (ILD) 的患者。迫切需要一种简单、廉价且可重复的生物标志物来评估疾病严重程度和死亡风险。这项回顾性多队列研究评估了 416 名接受抗纤维化治疗的 ILD 患者的中性粒细胞与淋巴细胞比率 (NLR)（Hamamatsu 队列，n = 217；Seirei 队列，n = 199）。在治疗开始时和治疗 1 年时评估死亡风险与 NLR 的关系。根据死亡风险选择最佳 NLR 截止值 2.7。高 NLR 患者的生存期比低 NLR 患者短（中位生存期：2.63 年 vs. 4.01 年）。NLR 分类结果（截止值：2.7）在 >70% 的患者中纵向保留，并且 NLR 持续较高的患者比其他患者具有更高的死亡风险（中位数为 2.97 岁 vs. 4.42 岁）。在多变量分析中，高 NLR 与死亡率显着相关，与年龄、性别、用力肺活量、一氧化碳肺弥散能力 (D) 或性别-年龄-生理学 (GAP) 指数无关。GAP 指数与 NLR 的综合评估将死亡风险分为四组。子集分析显示，NLR 评估更适用于没有晚期疾病、未服用类固醇和特发性肺纤维化 (IPF) 的患者，而不是晚期疾病、服用类固醇和非 IPF 的患者。高 NLR 与接受抗纤维化治疗的 ILD 患者死亡风险增加相关。NLR 评估可能有助于预测抗纤维化治疗中的疾病严重程度和死亡风险。