ArticleEClinicalMedicine2023
Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis.
Article in EClinicalMedicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- A meta-analysis of the clinical significance of neutrophil-to-lymphocyte ratios in interstitial lung disease.PloS one · 2023Pooled it
- Admission-Based Machine-Learning Models for Predicting Mechanical Ventilation and Mortality in Fibrotic Interstitial Lung Disease: A Multicenter Cohort Study with External Validation.Balkan medical journal · 2026Article
- Baseline neutrophil-to-lymphocyte ratio predicts survival time after the initiation of nintedanib in patients with interstitial lung disease.BMC pulmonary medicine · 2026Article
- Immunological mechanisms and therapeutic approaches in pulmonary fibrosis.European respiratory review : an official journal of the European Respiratory Society · 2026Review
- Linear association between the systemic immune-inflammation index and all-cause mortality in patients with interstitial lung disease: a retrospective cohort study.Frontiers in medicine · 2026Article
- The Role of NLR and Ferritin Levels as Biomarkers for Corticosteroid Dosage in Children with RefractoryJournal of inflammation research · 2026Article
- Neutrophils in idiopathic pulmonary fibrosis patients are phenotypically distinct from controls.ERJ open research · 2025Article
- A combined measure of blood leukocytes, forced vital capacity and quantitative CT is highly predictive of mortality in IPF: results of a single-centre cohort study.BMC pulmonary medicine · 2025Article
- A Simple Ratio in a Complex Disease: Exploring the Neutrophil-to-Lymphocyte Ratio in Idiopathic Pulmonary Fibrosis.Journal of clinical medicine · 2025Review
- CD206 and dust particles are prognostic biomarkers of progressive fibrosing interstitial lung disease associated with air pollutant exposure.Scientific reports · 2025Article
- Long-term outcome of interstitial lung disease in patients with primary Sjögren's syndrome: a retrospective observational study.The Korean journal of internal medicine · 2025Observational
- Neutrophils as key drivers of pulmonary fibrosis: unveiling mechanisms and therapeutic implications.Frontiers in immunology · 2025Review
- The Prognostic Role of Advanced Lung Cancer Inflammation Index in Patients with Idiopathic Pulmonary Fibrosis.Journal of clinical medicine · 2024Article
- Review
- Baseline neutrophil-to-lymphocyte ratio as a predictor of response to hospitalized bronchiectasis exacerbation risks.European clinical respiratory journal · 2024Article
- Neutrophil-lymphocyte ratio in patients with idiopathic pleuroparenchymal fibroelastosis.BMJ open respiratory research · 2023Article
- Article
- Neutrophil levels correlate with quantitative extent and progression of fibrosis in IPF: results of a single-centre cohort study.BMJ open respiratory research · 2023Article
- Acute Exacerbations of Interstitial Lung Diseases: Focus on Biomarkers.International journal of molecular sciences · 2023Review
- Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes ofFrontiers in immunology · 2023Article
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Authors and funding
30 authors at 9 institutions in 2 countries.
Funding
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.
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