Increased monocyte count and red cell distribution width as prognostic biomarkers in patients with Idiopathic Pulmonary Fibrosis

Theodoros Karampitsakos; Sebastiano Torrisi; Katerina Antoniou; Effrosyni Manali; Ioanna Korbila; Ourania Papaioannou; Fotios Sampsonas; Matthaios Katsaras; Eirini Vasarmidi; Despoina Papakosta; Kalliopi Domvri; Eva Fouka; Ioannis Organtzis; Zoe Daniil; Ilias Dimeas; Paraskevi Kirgou; Konstantinos I Gourgoulianis; Ilias C Papanikolaou; Katerina Markopoulou; Georgia Kounti; Eirini Tsapakidou; Efthymia Papadopoulou; Konstantinos Tatsis; Athena Gogali; Konstantinos Kostikas; Vasilios Tzilas; Serafeim Chrysikos; Spyridon Papiris; Demosthenes Bouros; Michael Kreuter; Argyrios Tzouvelekis

doi:10.1186/s12931-021-01725-9

Increased monocyte count and red cell distribution width as prognostic biomarkers in patients with Idiopathic Pulmonary Fibrosis

Respir Res. 2021 May 5;22(1):140. doi: 10.1186/s12931-021-01725-9.

Authors

Theodoros Karampitsakos¹, Sebastiano Torrisi^{2

3}, Katerina Antoniou⁴, Effrosyni Manali⁵, Ioanna Korbila⁵, Ourania Papaioannou¹, Fotios Sampsonas¹, Matthaios Katsaras¹, Eirini Vasarmidi⁴, Despoina Papakosta⁶, Kalliopi Domvri⁶, Eva Fouka⁶, Ioannis Organtzis⁶, Zoe Daniil⁷, Ilias Dimeas⁷, Paraskevi Kirgou⁷, Konstantinos I Gourgoulianis⁷, Ilias C Papanikolaou⁸, Katerina Markopoulou⁹, Georgia Kounti⁹, Eirini Tsapakidou⁹, Efthymia Papadopoulou⁹, Konstantinos Tatsis¹⁰, Athena Gogali¹⁰, Konstantinos Kostikas¹⁰, Vasilios Tzilas¹¹, Serafeim Chrysikos¹², Spyridon Papiris⁵, Demosthenes Bouros^#¹¹, Michael Kreuter^#^{2

3}, Argyrios Tzouvelekis^#^{13

14}

Affiliations

¹ Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece.
² Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
³ German Center for Lung Research, Heidelberg, Germany.
⁴ Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
⁵ 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁶ Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. PAPANIKOLAOU'' General Hospital, Exochi, Thessaloniki, Greece.
⁷ Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece.
⁸ Respiratory Medicine Department, "Corfu General Hospital", Corfu, Greece.
⁹ Pulmonary Department "G. PAPANIKOLAOU" General Hospital, Thessaloniki, Greece.
¹⁰ Department of Respiratory Medicine, Medical School, University of Ioannina, Ioannina, Greece.
¹¹ First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
¹² 5th Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Athens, Greece.
¹³ Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece. atzouvelekis@upatras.gr.
¹⁴ First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Medical School, National and Kapodistrian University of Athens, Athens, Greece. atzouvelekis@upatras.gr.

^# Contributed equally.

Abstract

Background: Idiopathic Pulmonary Fibrosis (IPF) represents a chronic lung disease with unpredictable course.

Methods: We aimed to investigate prognostic performance of complete blood count parameters in IPF. Treatment-naïve patients with IPF were retrospectively enrolled from two independent cohorts (derivation and validation) and split into subgroups (high and low) based on median baseline monocyte count and red cell distribution width (RDW).

Results: Overall, 489 patients (derivation cohort: 300, validation cohort: 189) were analyzed. In the derivation cohort, patients with monocyte count ≥ 0.60 K/μL had significantly lower median FVC%pred [75.0, (95% CI 71.3-76.7) vs. 80.9, (95% CI 77.5-83.1), (P = 0.01)] and DLCO%pred [47.5, (95% CI 44.3-52.3) vs. 53.0, (95% CI 48.0-56.7), (P = 0.02)] than patients with monocyte count < 0.60 K/μL. Patients with RDW ≥ 14.1% had significantly lower median FVC%pred [75.5, (95% CI 71.2-79.2) vs. 78.3, (95% CI 76.0-81.0), (P = 0.04)] and DLCO%pred [45.4, (95% CI 43.3-50.5) vs. 53.0, (95% CI 50.8-56.8), (P = 0.008)] than patients with RDW < 14.1%. Cut-off thresholds from the derivation cohort were applied to the validation cohort with similar discriminatory value, as indicated by significant differences in median DLCO%pred between patients with high vs. low monocyte count [37.8, (95% CI 35.5-41.1) vs. 45.5, (95% CI 41.9-49.4), (P < 0.001)] and RDW [37.9, (95% CI 33.4-40.7) vs. 44.4, (95% CI 41.5-48.9), (P < 0.001)]. Patients with high monocyte count and RDW of the validation cohort exhibited a trend towards lower median FVC%pred (P = 0.09) and significantly lower median FVC%pred (P = 0.001), respectively. Kaplan-Meier analysis in the derivation cohort demonstrated higher all-cause mortality in patients with high (≥ 0.60 K/μL) vs. low monocyte count (< 0.60 K/μL) [HR 2.05, (95% CI 1.19-3.53), (P = 0.01)].

Conclusions: Increased monocyte count and RDW may represent negative prognostic biomarkers in patients with IPF.

Keywords: Biomarkers; Idiopathic pulmonary fibrosis; Monocyte count; Mortality; RDW.

Publication types

Multicenter Study
Observational Study
Validation Study

MeSH terms

Aged
Erythrocyte Indices*
Erythrocytes*
Female
Greece / epidemiology
Humans
Idiopathic Pulmonary Fibrosis / blood
Idiopathic Pulmonary Fibrosis / diagnosis*
Idiopathic Pulmonary Fibrosis / mortality
Idiopathic Pulmonary Fibrosis / physiopathology
Leukocyte Count
Lung / physiopathology
Male
Monocytes*
Predictive Value of Tests
Prognosis
Reproducibility of Results
Retrospective Studies
Vital Capacity