The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis
The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects. We reviewed IPF patient records from two indepen...
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| Veröffentlicht in: | Respiratory medicine 2020-08, Vol.170, p.106068-106068, Article 106068 |
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| creator | Nathan, Steven D. Brown, A. Whitney Mogulkoc, Nesrin Soares, Flavia Collins, Ashley C. Cheng, Joyce Peterson, Jake Cannon, Brenna King, Christopher S. Barnett, Scott D. |
| description | The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects.
We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.
There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 109 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC |
| doi_str_mv | 10.1016/j.rmed.2020.106068 |
| format | Article |
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We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.
There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 109 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05–1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09–2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92).
Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.
•The whole blood cell count (WBC) is a routine readily available test.•The WBC provides important independent prognostic information in IPF patients.•The WBC may be useful to risk stratify IPF patients.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2020.106068</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Biomarkers ; Blood ; Clinical outcomes ; Demography ; Fibrosis ; Hospitalization ; Idiopathic pulmonary fibrosis ; Interstitial ; Laboratory tests ; Leukocyte count ; Lung diseases ; Medical prognosis ; Multivariate analysis ; Neutrophils ; Patients ; Pulmonary fibrosis ; Steroids ; Survival ; Survival analysis ; Transplants & implants ; Variables</subject><ispartof>Respiratory medicine, 2020-08, Vol.170, p.106068-106068, Article 106068</ispartof><rights>2020 Elsevier Ltd</rights><rights>2020. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-d56eb2dc65dfae5abedc0a05c0437c5792dca6ea36859a1a564bf95e5e464c173</citedby><cites>FETCH-LOGICAL-c405t-d56eb2dc65dfae5abedc0a05c0437c5792dca6ea36859a1a564bf95e5e464c173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0954611120302080$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids></links><search><creatorcontrib>Nathan, Steven D.</creatorcontrib><creatorcontrib>Brown, A. Whitney</creatorcontrib><creatorcontrib>Mogulkoc, Nesrin</creatorcontrib><creatorcontrib>Soares, Flavia</creatorcontrib><creatorcontrib>Collins, Ashley C.</creatorcontrib><creatorcontrib>Cheng, Joyce</creatorcontrib><creatorcontrib>Peterson, Jake</creatorcontrib><creatorcontrib>Cannon, Brenna</creatorcontrib><creatorcontrib>King, Christopher S.</creatorcontrib><creatorcontrib>Barnett, Scott D.</creatorcontrib><title>The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis</title><title>Respiratory medicine</title><description>The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects.
We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.
There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 109 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05–1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09–2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92).
Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.
•The whole blood cell count (WBC) is a routine readily available test.•The WBC provides important independent prognostic information in IPF patients.•The WBC may be useful to risk stratify IPF patients.</description><subject>Biomarkers</subject><subject>Blood</subject><subject>Clinical outcomes</subject><subject>Demography</subject><subject>Fibrosis</subject><subject>Hospitalization</subject><subject>Idiopathic pulmonary fibrosis</subject><subject>Interstitial</subject><subject>Laboratory tests</subject><subject>Leukocyte count</subject><subject>Lung diseases</subject><subject>Medical prognosis</subject><subject>Multivariate analysis</subject><subject>Neutrophils</subject><subject>Patients</subject><subject>Pulmonary fibrosis</subject><subject>Steroids</subject><subject>Survival</subject><subject>Survival analysis</subject><subject>Transplants & implants</subject><subject>Variables</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LxDAURYMoOH78AVcBN246JmmSmYIbEb9AcDOuQ5q8MiltMiapg__elHHlwlXg5dzHuwehK0qWlFB52y_jCHbJCJsHksj1EVpQUbOqJpIfowVpBK8kpfQUnaXUE0IazskC9ZstYJ1SME5nFzxuIe8BPN5vXQbcDiFYbGAYsAmTz1h7i8OUTRghYefxrqTA54T3Lm-xsy6UydYZvJuGMXgdv3Hn2hiSSxfopNNDgsvf9xx9PD1uHl6qt_fn14f7t8pwInJlhYSWWSOF7TQI3YI1RBNhCK9XRqya8qcl6FquRaOpFpK3XSNAAJfc0FV9jm4Oe3cxfE6QshpdmitoD2FKipU9vEgTrKDXf9A-TNGX62ZKMkk5o4ViB8qUHilCp3bRjaWaokTN-lWvZv1q1q8O-kvo7hCCUvXLQVTJFFMGrItgsrLB_Rf_ATnpj9Y</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Nathan, Steven D.</creator><creator>Brown, A. 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Whitney ; Mogulkoc, Nesrin ; Soares, Flavia ; Collins, Ashley C. ; Cheng, Joyce ; Peterson, Jake ; Cannon, Brenna ; King, Christopher S. ; Barnett, Scott D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-d56eb2dc65dfae5abedc0a05c0437c5792dca6ea36859a1a564bf95e5e464c173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biomarkers</topic><topic>Blood</topic><topic>Clinical outcomes</topic><topic>Demography</topic><topic>Fibrosis</topic><topic>Hospitalization</topic><topic>Idiopathic pulmonary fibrosis</topic><topic>Interstitial</topic><topic>Laboratory tests</topic><topic>Leukocyte count</topic><topic>Lung diseases</topic><topic>Medical prognosis</topic><topic>Multivariate analysis</topic><topic>Neutrophils</topic><topic>Patients</topic><topic>Pulmonary fibrosis</topic><topic>Steroids</topic><topic>Survival</topic><topic>Survival analysis</topic><topic>Transplants & implants</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nathan, Steven D.</creatorcontrib><creatorcontrib>Brown, A. Whitney</creatorcontrib><creatorcontrib>Mogulkoc, Nesrin</creatorcontrib><creatorcontrib>Soares, Flavia</creatorcontrib><creatorcontrib>Collins, Ashley C.</creatorcontrib><creatorcontrib>Cheng, Joyce</creatorcontrib><creatorcontrib>Peterson, Jake</creatorcontrib><creatorcontrib>Cannon, Brenna</creatorcontrib><creatorcontrib>King, Christopher S.</creatorcontrib><creatorcontrib>Barnett, Scott D.</creatorcontrib><collection>CrossRef</collection><collection>Virology and AIDS Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nathan, Steven D.</au><au>Brown, A. Whitney</au><au>Mogulkoc, Nesrin</au><au>Soares, Flavia</au><au>Collins, Ashley C.</au><au>Cheng, Joyce</au><au>Peterson, Jake</au><au>Cannon, Brenna</au><au>King, Christopher S.</au><au>Barnett, Scott D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis</atitle><jtitle>Respiratory medicine</jtitle><date>2020-08</date><risdate>2020</risdate><volume>170</volume><spage>106068</spage><epage>106068</epage><pages>106068-106068</pages><artnum>106068</artnum><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects.
We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.
There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 109 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05–1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09–2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92).
Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.
•The whole blood cell count (WBC) is a routine readily available test.•The WBC provides important independent prognostic information in IPF patients.•The WBC may be useful to risk stratify IPF patients.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><doi>10.1016/j.rmed.2020.106068</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biomarkers Blood Clinical outcomes Demography Fibrosis Hospitalization Idiopathic pulmonary fibrosis Interstitial Laboratory tests Leukocyte count Lung diseases Medical prognosis Multivariate analysis Neutrophils Patients Pulmonary fibrosis Steroids Survival Survival analysis Transplants & implants Variables |
| title | The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis |
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