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You can make submissions to other journals here. Notice You are accessing a machine-readable. Continue Cancel. Article Menu. Maria Man, A. Milena Alexescu, T. Gabriela Motoc, N. Stefania Tarmure, S. Ungur, R. Ana Todea, D. Adina Coste, S. Cezara Valean, D. Pop, M. Ruta, V. Need Help? Support Find support for a specific problem in the support section of our website.

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Open Access Article. Adina Milena Man. Teodora Gabriela Alexescu. Nicoleta Stefania Motoc. Simina Tarmure. Rodica Ana Ungur. Doina Adina Todea. Sorina Cezara Coste. Dan Valean. Monica Carmen Pop. This article belongs to the Section Pulmonary. Background and objectives: The aims of the study were to evaluate the utility of neutrophil-to-lymphocyte ratio NLR and the systemic immune-inflammation index SII as inflammation markers and prognostic factors in patients with known interstitial lung disease secondary to connective tissue diseases CTD-ILD compared with idiopathic pulmonary fibrosis IPF.

The mean NLR value was 3. There was however a clinically ificant statistical difference when compared with the control group, where NLR was 2. SII values were In the context of non-exacerbated interstitial lung disease, NLR and SII have reduced numerical values, without being statistically correlated with prognosis when we compared with patients with connective tissue diseases without exacerbation or with healthy people, the cut off being of 2.

However subsequent studies in larger patient samples might provide changes in these cut-off values.

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These diseases have different clinical, biological, and imagistic features that could help in their differentiation and the final diagnosis. The traits on the HRCT reticulation, traction bronchiectasis, ground glass or honey combing in different combinations form a certain CT pattern that could be differentiated from several clinical entities or diseases. For instance, a specific form of chronic fibrosing interstitial pneumonia, of unknown etiology, limited to the lung is a usual interstitial pneumonia pattern UIP. IPF prevalence ranges from 1. It affects adults, especially men, aged over 50 years and has a poor prognosis, as death typically occurs at 2—4 years after diagnosis [ 5 ].

It is influenced by personal factors smoking status, comorbidities, etc. Connective tissue disease CTD is a group of autoimmune disorders from which the most common, rheumatoid arthritis RAaffects between 0. The lung ultrasound LUS is a non-invasive imaging technique that may become an important instrument to detect patients with suspected ILD [ 8 ].

The multidisciplinary discussions MDD could suggest diagnosis with or without the need for invasive investigations e. Accurate diagnosis is extremely important due to the therapeutic options and the long-term prognosis [ 9 ]. There is an increasing interest in research for a better understanding of ILD to identify prognostic and predictive factors with cheap, simple and easier to obtain tests such as blood tests. A of studies described in ILD mild hematological changes, such as anemia, leukocytosis, leukopenia, lymphopenia, eosinophilia, thrombocytopenia.

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The neutrophil-to-lymphocyte ratio NLR is a marker of subclinical inflammation, with a higher values in exacerbations, in many lung diseases such as cancer, COPD, asthma, bronchiectasis, obstructive sleep apnea severity, obesity, and many cardiac diseases ischemic heart disease, myocardial infraction [ 101112 ].

Patients with a higher NLR value have a relatively low lymphocyte count and a high neutrophil count and indirectly evaluates inflammatory status as well as cell-mediated immunity [ 13 ]. The systemic immune-inflammation SII indexas a novel inflammation-related index, is a comprehensive combination based on peripheral lymphocyte, neutrophil, and platelet counts. According to studies, SII may have a high prognostic value in cancer patients, and an elevated pretreatment SII is associated with poor outcomes in cancer patients [ 15 ]. Unlike other inflammatory biomarkers, such as erythrocyte sedimentation rate ESR and C-reactive protein CRPthe NLR and the systemic immune-inflammation index are derived from complete routine tests.

They require no special technique, making them therefore rapidly accessible [ 16 ]. Our hypothesis was that, as in idiopathic pulmonary fibrosis the inflammation is low, and fibrosis is predominantly a pathogenetic finding localized in the lung, NLR should have smaller values than in CTD-ILD where the inflammation is systemic. The aims of the study are to evaluate the value and the cut-off of the neutrophil-to-lymphocyte ratio NRL and of the systemic immune-inflammation index SII as inflammatory status markers in patients with IPF compared with known interstitial lung diseases CTD-ILD and healthy people.

Their possible role as a prognostic factor was also briefly analyzed. This is a retrospective observational study conducted in the Tertiary Teaching Pulmonology Hospital from Cluj-Napoca over a period of 18 months, from January until June All patients with known interstitial lung disease diagnosed made according to the current existing guidelinesover 18 years old, admitted consecutively in the pulmonology wards were included. All patients with other chronic respiratory diseases e.

A control healthy group matched for age and sex was also evaluated for comparation. All patients ed an informed consent. Study protocol: Demographic and laboratory data were collected from all charts of patients who were included in the study. Blood samples were collected from all the patients at admission to the hospital. Complete blood cell counts, and differential values were recorded. The NLR ratio was defined as the absolute count of neutrophils divided by the absolute count of lymphocytes.

The absolute neutrophil count cut-off was established according to the cut-offs accepted in Romania, between: 1. HRCT pattern was recorded in standard of care, and multidisciplinary discussions MDD made the final diagnosis according with international guidelines. The data were collected, and the database was created using Microsoft Excel software. The normal distribution of the data was checked with the Shapiro—Wilk test. To evidence the mean value of the parameters, standard deviation was used.

For the comparison of two continuous quantitative variables, the Spearman—Rho test was used. Qualitative data was described using counts and percentages; the link between two qualitative data was tested using the Chi2 test with a ificance level of 0.

: The characteristics of all the included patients 42 patients with interstitial lung disease—group I and 42 healthy controls—group II are shown in Table 1. The age and sex matched controls were included. Characteristics of the studied groups are shown in Table 1. In the first group there were 24 There was a statistically ificant difference in age between the two ILD patients groups: in the IPF group the mean age was During hospitalization 6 deaths were recorded in the IPF group. Mean NLR value was 3. There was, however, a ificantly statistical difference in both NLR and lymphocytes values in patients with ILD when compared with healthy subjects Table 1.

In the control group mean NLR was 2. Although not ificant when comparing smoking status among patients with interstitial lung diseases versus healthy subjects, it is clinically ificant at a subgroup analysis see Table 2 and Table 3. When looking at the SII there was not a statistically Online sex chat room in Piriu Negrii difference in the analyzed groups: in the IPF group the mean value was These rapid and easy-to-use biomarkers are minimally influenced by physiological, pathological and physical factors [ 17 ] and could evaluate severity and immediate mortality risk.

We did not find any statistically ificant difference in NLR and SII in the analyzed groups, nor could we associate a higher value with a poor outcome. The mean NLR value in both groups was 2. There was not a statistically ificant difference in SII between the analyzed group and healthy subjects, suggesting that this variable could have less utility as a marker for the existing subclinical inflammation in interstitial lung disease.

Inflammation probably plays a role in the pathogenesis and progression of pulmonary fibrosis. However, the mechanisms related to IPF and non-specific pulmonary fibrosis are not well characterized and differentiated. Nevertheless, recent data suggest that IPF pathophysiology is rather Online sex chat room in Piriu Negrii product of fibroblast dysfunction than persistent inflammation. Inflammation in the pathogenesis of the disease is attributed to atypical patients and to the biological samples obtained during disease exacerbations [ 17 ].

Patho-physiologically, inflammation induces an increase in neutrophil and thrombocyte count, accompanied by a decrease in lymphocyte count [ 14 ]. Neutrophils play a more important role in inflammatory disorders than macrophages; they are the distinctive of acute inflammation [ 18 ]. Neutrophils are immature phagocytes, which release proteolytic enzymes and free radicals that enhance the inflammatory processes, and their persistence causes anarchic structural changes with unpredictable local lesions [ 19 ].

The literature reports different NLR values, using different methods, in various populations neoplastic or not.

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Currently, there is no universal value available. The accepted normal NLR values in an adult, non-geriatric population in good health vary between 0.

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The group of patients selected in our study had a mean age of On the other hand, this fit within the limits might be deceiving. Studies conducted in patients with liver fibrosis, which evaluated the NLR as a marker for the severity of liver fibrosis in patients with chronic viral hepatitis B CHBshowed that CHB patients with advanced fibrosis have a ificantly lower NLR than CHB patients without minimal fibrosis [ 18 ]. In addition, the lower NLR value in deceased patients supports the presence of a non-inflammatory component in the disease progression. Patients with a predominantly fibrosing reaction have a much worse prognosis compared to patients with a predominant inflammatory reaction [ 21 ].

The cut-off value is highly controversial; for example, in patients with systemic involvement such as systemic sclerosis SScNLR values higher than 2. ILD is one of the most common and important complications of SSc. These patients may remain asymptomatic [ 20 ]. All patients with systemic involvement in our study had NLR values over 2. Increased NLR values can be used as a marker similar to CRP in determining extensive inflammation [ 23 ] in patients with connective tissue diseases [ 19 ] because an increase in CRP may occur late during the evolution of the disease compared to NLR increase [ 24 ].

Bohrade and colleagues reported that using NLR changes in time could be used to predict the clinical outcomes. Increased values also correlate with disease severity [ 26 ]. Starting from these findings, it would be useful in the future to investigate patients Online sex chat room in Piriu Negrii known systemic involvement, with NLR values over 2. Furthermore, it is known that inflammatory markers increase with population aging, growing levels of obesity and increasing osteoarthritis being part of the aging process and becoming a risk factor for morbidity and mortality among the elderly [ 2829 ].

NLR is a primary marker for this biological process. This theory might explain the slightly higher mean NLR value, although statistically inificant, in the group with idiopathic fibrosis compared to NSIP [ 28 ]. Moreover, scientific evidence supports that stress can activate the inflammatory cascade [ 29 ].

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Online sex chat room in Piriu Negrii