The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis

Abstract

Variable patterns of disease progression are typically observed in patients with idiopathic pulmonary fibrosis (IPF). We sought to determine the prognostic capacity of blood cell count indexes, derived from routine complete blood cell (CBC) count, in a cohort of IPF patients. The neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were calculated at baseline in a consecutive series of 82 IPF patients followed for four years. After adjusting for age, gender, body mass index, smoking status, and disease stage, only the AISI was significantly associated with mortality (HR 1.0013, 95% CI 1.0003–1.0023, p = 0.015). Patients with AISI <434 and ≥434 had a median survival from the diagnosis of 35.3 ± 15.2 and 26.6 ± 16.3 months (p = 0.015), and a four-year survival rate of 54% and 34%, respectively. The AISI, easily derivable from routine laboratory tests, is independently associated with mortality in patients with IPF. Prospective studies in larger cohorts are required to confirm this association.

Inflammatory indices obtained from routine blood tests show an inflammatory state associated with disease progression in engineered stone silicosis patients

“…WBC count and its derived indicators such as the neutrophil-to-lymphocyte ratio (NLR) based on the coexistence of lymphopenia and leukocytosis in the initial inflammatory response 17 , 18 , lymphocyte-to-monocyte ratio (LMR) can reflect the body’s immune status, and its decrease indicates host immune dysfunction 19 , platelet-to-lymphocyte ratio (PLR) is an inflammatory marker of immune-mediated, metabolic, prothrombotic, and neoplastic diseases 20 , have been considered as predictors of severity and prognosis of the disease although, by combining several of these parameters, the prediction can be greatly improved. Then, others more inclusive ratios such as: (i) neutrophil x monocyte-to-lymphocyte ratio (systemic inflammation response index or SIRI), which has a stronger stability than NLR and an elevated SIRI suggests increased inflammation and reduced immune response in patients 21 , 22 ; (ii) neutrophil x platelet-to-lymphocyte ratio (systemic immune-inflammation index or SII) with poor prognosis when augmented 23 , 24 and (iii) neutrophil x monocyte x platelet-to-lymphocyte ratio (aggregate index of systemic inflammation or AISI) 25 have been proposed as cheap and easily measurable biomarkers or indicators to improve the diagnosis/prognosis in numerous and different pathologies. All these indices can be used as indicators of inflammatory state and severity to evaluate the diagnosis and the clinical prognosis of patients with ES silicosis because, although clinical and radiologic factors may assist in predicting the likelihood of complications and mortality from ES silicosis, evaluating the prognosis of these patients remains challenging.…”

Neutrophil Counts, Neutrophil-to-Lymphocyte Ratio, and Systemic Inflammatory Response Index (SIRI) Predict Mortality after Off-Pump Coronary Artery Bypass Surgery

“…Although AISI represents several inflammatory cells as ingredients and should provide more precise prognostic value, it is rarely used or described in the literature. Most recently, Zinellu et al (2021) underlined its prognostic significance to predict poor outcomes in idiopathic pulmonary fibrosis [ 72 ]. Furthermore, Hamad and coworkers (2021) also studied its importance in patients suffering from COVID-19 [ 23 ].…”

Blood monocyte counts as a prognostic biomarker and predictor in Chinese patients with idiopathic pulmonary fibrosis

“…These prognostic scoring systems were different combinations of blood biomarkers. Angelo et al found that AISI was independently associated with IPF, as well as mortality in patients with IPF ( 10 , 11 ). In our study, we combined monocyte with clinical and physiological indicators to predict mortality risk in Chinese patients with IPF.…”