| ObjectiveThis study focused on the expression difference of peripheral blood cell parameters related to inflammation between stable and acute exacerbations of IPF,and evaluated their value in acute exacerbations and survival prognosis of patients with IPF.To identify and validate risk stratification in patients with IPF by screening out easy-to-measure prognostic biomarkers to improve patient clinical outcomes.MethodsThe clinical data of 150 patients with IPF hospitalized in the Department of Respiratory Medicine,the First Hospital of Lanzhou University from January 2017 to December 2021 were collected.According to the inclusion and exclusion criteria,a total of 113 patients with IPF were enrolled in this study,including 88 males and 25 females.According to the clinical type,the patients were divided into the acute exacerbation of IPF group(41 cases)and the stable IPF group(72 cases).The basic clinical data,laboratory indicators,pulmonary function indicators,blood gas analysis and other data of the subjects after admission were collected,and the survival time of patients with IPF was followed up.The risk factors for acute exacerbation and poor prognosis of IPF patients were compared and analyzed.Results(1)There was significant difference in smoking index between AE-IPF group and stable IPF group(P < 0.05),but no significant difference in gender,age,BMI,hypertension and diabetes(P > 0.05).(2)There were significant differences in WBC,NEUT,MONO,RDW,LMR,AISI,SIRI and SII between the AE-IPF group and the stable IPF group(P < 0.05),but there were no significant differences in LY,PLT,PDW,NLR,d NLR and PLR(P >0.05).(3)There were significant differences in FVC %,FEV1%,TLC %,DLCO %,Pa O2 and P/F between AE-IPF group and IPF stable group(P < 0.05),but no significant difference in Pa CO2(P > 0.05).(4)WBC,NEUT,MONO,RDW,NLR,d NLR,AISI,SIRI were negatively correlated with DLCO %(r =-0.270,-0.254,-0.244,-0.345,-0.230,-0.195,-0.211,-0.280,respectively,all P < 0.05).LMR was positively correlated with DLCO %(r=0.206,P < 0.05).MONO,RDW,NLR,AISI and SIRI were negatively correlated with P/F(r =-0.223,-0.260,-0.224,-0.225,-0.264,respectively,all P < 0.05).LMR was positively correlated with P/F(r=0.284,P < 0.05).(5)Logistic multivariate regression analysis showed that MONO and P/F were independent influencing factors for acute exacerbations in IPF patients,and MONO was an independent risk factor for acute exacerbations in IPF patients.ROC curve results showed that the AUC of MONO in the diagnosis of AE-IPF was 0.729,the sensitivity was 75.6%,and the specificity was 63.9%.AISI was able to diagnose AE-IPF with an AUC of 0.715,a sensitivity of 61% and a specificity of 76.4%.The AUC of SIRI diagnosis of AE-IPF was 0.707,the sensitivity was 51.2%,and the specificity was 83.3%.The AUC,sensitivity and specificity of AE-IPF diagnosed by LMR were 0.693,58.5% and 73.6%.The combined ROC curve of the four indexes was drawn,and it was found that the predictive ability of the combined indexes was higher than that of the four single indexes,with an AUC of 0.743,a sensitivity of75.6% and a specificity of 65.3%.(6)The univariate COX proportional hazard regression model analysis of indicators that may be associated with poor prognosis of IPF patients found that the factors associated with the prognosis of IPF were WBC,MONO,RDW,SIRI,DLCO %,P/F.The HR of WBC,MONO,RDW and SIRI is greater than 1,which is considered to be negatively correlated with the prognosis of IPF.DLCO % and HR of P/F were less than 1,which were considered to be positively correlated with the prognosis of IPF.Significant indicators in univariate COX proportional hazard regression analysis were included in multivariate COX proportional hazard regression analysis,and the results showed that WBC,DLCO % and P/F were related factors affecting the prognosis of IPF.DLCO % and HR of P/F were positively correlated with the prognosis of IPF.The HR of WBC is greater than 1,which is negatively correlated with the prognosis of IPF,and is an independent risk factor for the prognosis of IPF patients.The ROC curve showed that the AUC,sensitivity and specificity of WBC in diagnosing IPF was 0.740,79.2% and 68.6%.Conclusions(1)WBC,MONO,NEUT,NLR,d NLR,LMR,AISI,SIRI,SII,and RDW are closely related to acute exacerbation in patients with IPF,and MONO is an independent risk factor for acute exacerbation in patients with IPF.(2)The combination of MONO,LMR,AISI and SIRI has a moderate predictive value for acute exacerbation in patients with IPF,and its predictive ability is stronger than that of the four independent indicators.(3)WBC,MONO,NEUT,NLR,d NLR,AISI,SIRI,SII,and RDW were negatively correlated with DLCO % and P/F,respectively,suggesting that the higher the above indicators,the worse the lung function.However,LMR was positively correlated with DLCO % and P/F,suggesting that the lower the index,the worse the lung function.(4)WBC,MONO and RDW are closely related to the prognosis of IPF patients,among which WBC is an important risk factor for the prognosis of IPF patients. |
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