Serum levels and ratios between different white blood cells may be accurate predictors of disease prognosis and progression in patients with idiopathic pulmonary fibrosis (IPF), according to a study recently published in BMJ Open Respiratory Research.

“These simple and easy to measure components of the full blood count have potential utility as biomarkers for lung function decline in IPF. This should be taken forward by prospective and validation studies,” the authors said.

The most revealing finding was that although increases in monocytes and neutrophils corresponded to higher all-cause mortality, a Kaplan-Meier analysis demonstrated that only neutrophils are associated with worsening forced vital capacity (FVC). Similarly, higher neutrophil levels, neutrophil to lymphocyte ratio, and lymphopenia also correlated with lower FVC parameters.

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To achieve these results, a retrospective analysis that included 128 patients previously diagnosed with IPF correlated blood levels of monocytes, neutrophils, and lymphocytes with all-cause mortality and worsening FVC during a median follow-up of 31 months. Out of all participants, 41.4% exhibited a decline in FVC of 10% or more per year, while almost half of the sample (43.8%) died.

Even though previous publications have already detected an important role of neutrophils, monocytes, and lymphocytes in the pathogenesis of IPF, their actual significance in daily medical practice still remains unclear.

This study suggests that serial blood work that is already usually routinely performed on these patients may further aid in alerting disease progression and hence guide the decision-making process regarding the therapeutic approach, as explained by Achaiah et al.

“Peripheral blood leucocyte measurements taken from full blood count analysis could be utilised to stratify IPF patients to those more likely to progress, and perhaps prioritised for antifibrotic treatment,” the authors wrote.

Finally, the article acknowledges some limitations. For example, the small sample size and single-center nature call for subsequent research on this topic to definitely validate these results.


Achaiah A, Rathnapala A, Pereira A, et al. Neutrophil lymphocyte ratio as an indicator for disease progression in idiopathic pulmonary fibrosis. BMJ Open Resp Res. Published online June 17, 2022.  doi:10.1136/ bmjresp-2022-001202