Three Steps to Cure Pulmonary Fibrosis. Step 1: The Runaway Train or Groundhog Day?

Jenkins, R Gisli

doi:10.1164/rccm.202002-0260ed

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Earlier detection of fibrotic ILAs could lead to a shorter lag time to ILD diagnosis, potentially allowing earlier treatment intervention and improved patient outcome [ 12 ]. Perhaps more pressing is a need for an easily accessible test to stratify patients according to those who are more likely to progress and therefore require follow-up.…”

Section: Introductionmentioning

confidence: 99%

Increased monocyte level is a risk factor for radiological progression in patients with early fibrotic interstitial lung abnormality

Achaiah

Lyon²,

Fraser³

et al. 2022

ERJ Open Res

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BackgroundInterstitial lung abnormalities (ILA) are specific spatial patterns on computed tomography scan (CT), potentially compatible with early interstitial lung disease (ILD). A proportion will progress; management involves risk stratification and surveillance. Elevated blood monocyte levels have been shown to associate with progression of IPF.AimsTo (i) estimate the proportion of “early fibrotic” ILAs (EF-ILA; reticular +/− ground glass opacities, excluding traction bronchiectasis and honeycombing) on CTs of patients attending all-indications thoracic CTs, and proportion demonstrating radiological progression and (ii) explore association between peripheral blood leukocyte levels and ILA progression.MethodsWe analysed all thoracic CT reports in individuals aged 45–75 performed between January-2015 and December-2020 in one large teaching hospital (Oxford, UK) to identify patient CT reports consistent with EF-ILA. CT-contemporaneous blood leukocyte counts were examined to explore contribution to progression and all-cause mortality, using multivariate Cox regression.Results40 711 patients underwent thoracic CT imaging during this period. 1259 (3.1%) demonstrated the EF-ILA pattern. Mean age; 65.4 (±7.32), male; 735 (47.8%). EF-ILA was significantly associated with all-cause mortality [HR 1.87, 95%CI 1.25–2.78, p=0.002]. 362 cases underwent at least one follow-on CT. Radiological progression was observed in 157 cases (43.4%); increase in reticulation; 51, new traction bronchiectasis; 84, and honeycombing; 22. Monocyte count, neutrophil count, monocyte:lymphocyte ratio, neutrophil:lymphocyte ratio and 'systemic inflammatory response index' were significantly associated with radiological progression.Conclusion3.1% of subjects requiring thoracic CT during a 6-year period demonstrated EF-ILA. Monocyte levels, and blood leukocyte-derived indexes were associated with radiological progression and could indicate which patients may require closer follow up.

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Section: Introductionmentioning

confidence: 99%