Diagnostic and prognostic biomarkers for progressive fibrosing interstitial lung disease

Abstract

No biomarkers have been identified in bronchoalveolar lavage fluid (BALF) for predicting fibrosis progression or prognosis in progressive fibrosing interstitial lung disease (PF-ILD). We investigated BALF biomarkers for PF-ILD diagnosis and prognosis assessment. Overall, 120 patients with interstitial pneumonia who could be diagnosed with PF-ILD or non PF-ILD were enrolled in this retrospective study. PF-ILD was diagnosed according to Cottin’s definition. All patients underwent bronchoscopy and BALF collection. We evaluated blood and BALF parameters, high-resolution computed tomography (HRCT) patterns, and spirometry data to identify factors influencing PF-ILD diagnosis and prognosis. On univariate logistic analysis, age, sex, the BALF white blood cell fraction (neutrophil, lymphocyte, eosinophil, and neutrophil-to-lymphocyte ratio), BALF flow cytometric analysis (CD8), and an idiopathic pulmonary fibrosis/usual interstitial pneumonia pattern on HRCT were correlated with PF-ILD diagnosis. Multivariate logistic regression analysis revealed that sex (male), age (cut-off 62 years, area under the curve [AUC] 0.67; sensitivity 0.80; specificity 0.47), white blood cell fraction in BALF (NLR, neutrophil, and lymphocyte), and CD8 in BALF (cut-off 34.2; AUC 0.66; sensitivity, 0.74; specificity, 0.62) were independent diagnostic predictors for PF-ILD. In BALF, the NLR (cut-off 8.70, AUC 0.62; sensitivity 0.62; specificity 0.70), neutrophil count (cut-off 3.0, AUC 0.59; sensitivity 0.57; specificity 0.63), and lymphocyte count (cut-off 42.0, AUC 0.63; sensitivity 0.77; specificity 0.53) were independent diagnostic predictors. In PF-ILD patients (n = 77), lactate dehydrogenase (cut-off 275, AUC 0.69; sensitivity 0.57; specificity 0.78), Krebs von den Lungen-6 (cut-off 1,140, AUC 0.74; sensitivity 0.71; specificity 0.76), baseline forced vital capacity (FVC) (cut-off 1.75 L, AUC 0.71; sensitivity, 0.93; specificity, 0.46), and BALF neutrophil ratio (cut-off 6.0, AUC 0.72; sensitivity 0.79; specificity 0.80) correlated with death within 3 years. The BALF cellular ratio, particularly the neutrophil ratio, correlated with the diagnosis and prognosis of PF-ILD. These findings may be useful in the management of patients with interstitial pneumonia.

The Promising Role of Oncomarkers CA 19-9 and CA 125 in the Diagnosis of Progressive Pulmonary Fibrosis

“…Таким образом, СА 19-9 и СА 125 стоят в одном ряду с такими биологическими маркерами как KL-6, сурфактантные протеины, и могут быть объедены в единую группу биологических маркеров эпителиального повреждения и анормальной репарации. Однако ни сурфактантые протеины, ни KL-6, несмотря на долгие годы изучения, не приблизились к имплементации в реальную клиническую практику [23][24][25][26]. Настоящие роль и место СА 19-9 и СА 125 в клинической практике еще предстоит изучить.…”

Biomarkers in idiopathic pulmonary fibrosis: Current insight and future direction

“…Integration with imaging techniques, particularly high-resolution computed tomography (HRCT), holds promise for enhancing IPF diagnosis and monitoring by pairing blood biomarkers with visual data. 32 As comprehension of IPF’s heterogeneity deepens, the prospects for personalized treatment strategies rooted in specific biomarker profiles become more feasible. This trajectory aligns with the recognition that addressing the intricacies of IPF necessitates collaborative efforts spanning research, clinical practice, and technological innovation [ Table 1 ].…”