Use of peripheral neutrophil to lymphocyte ratio and peripheral monocyte levels to predict survival in fibrotic hypersensitivity pneumonitis (fHP): a multicentre retrospective cohort study

The factors determining disease course and survival in fibrotic hypersensitivity pneumonitis (fHP) have not been fully elucidated.The aim of this study was to describe the characteristics of patients with fHP in a real-world cohort and investigate factors associated with worse outcomes. We aimed to explore the use of neutrophil to lymphocyte ratio (NLR) and peripheral blood monocyte levels in predicting mortality.MethodsA retrospective, multicentre, observational UK cohort study.ResultsPatients with fHP were significantly younger than those with idiopathic pulmonary fibrosis (IPF) (median age fHP 73 vs IPF 75 years) and were much more likely to be woman (fHP 61% vs IPF 26%). In almost half of all fHP cases (49%, n=104/211), no causative antigen was identified from either the history or specific antigen testing. Overall, fHP was associated with a better survival than IPF, although median survival of both groups was poor (fHP 62 months vs IPF 52 months).IPF survival in patients with a high NLR was significantly lower than those with a low NLR (44 vs 83 months). A monocyte count ≥0.95 K/uL also predicted significantly poorer outcomes for patients with IPF compared with <0.95 K/uL (33 vs 57 months). In contrast, NLR and monocyte count did not predict survival in the fHP cohort.ConclusionsAlthough fHP has a statistically lower mortality than IPF, absolute survival time of both conditions is poor. High baseline NLR and absolute monocyte counts predict worse survival in IPF but not in fHP, highlighting the potential for divergence in their pathogenic mechanisms.

Peripheral Neutrophil- Lymphocyte Ratio as a Predictor of Seizure in Preterm Infants with Intra-Ventricular Hemorrhage

Background: Preterm infants with Intra-Ventricular Hemorrhage (IVH) are at risk for developing significant complications, including post hemorrhagic hydrocephalus and seizures. Neonatal seizures are the most common overt manifestation of neurological dysfunction in the newborn, and is associated with short- and long-term adverse effects. Objective: The aim of the study is to evaluate the value of Peripheral Neutrophil- lymphocyte ratio (NLR) as a predictor of seizure in preterm infants with intra-ventricular hemorrhage. Methods: This prospective cohort study that comprised 60 Preterm infants with IVH admitted at NICU pediatric department Tanta university hospital from November 2019 to May 2020, Preterm infants were divided into two groups according to incidence of seizure. Preterm infants in this study subjected to Careful history taking, clinical examination and investigations (laboratory and Trans-cranial ultrasound) as well as analysis of result and follow up clinical status for development of seizure. Results: There was a statistically highly significant difference regarding NLR and development of seizure with p value <0.001 (NLR ≥ 2.3 with sensitivity 96%, specificity 93%, Area under the curve 0.849 and accuracy 84.9%). Conclusion: NLR is a predictor of seizure in preterm infants with intra-ventricular hemorrhage.

IFN signaling and neutrophil degranulation transcriptional signatures are induced during SARS-CoV-2 infection

SARS-CoV-2 virus has infected more than 92 million people worldwide resulting in the Coronavirus disease 2019 (COVID-19). Using a rhesus macaque model of SARS-CoV-2 infection, we have characterized the transcriptional signatures induced in the lungs of juvenile and old macaques following infection. Genes associated with Interferon (IFN) signaling, neutrophil degranulation and innate immune pathways are significantly induced in macaque infected lungs, while pathways associated with collagen formation are downregulated, as also seen in lungs of macaques with tuberculosis. In COVID-19, increasing age is a significant risk factor for poor prognosis and increased mortality. Type I IFN and Notch signaling pathways are significantly upregulated in lungs of juvenile infected macaques when compared with old infected macaques. These results are corroborated with increased peripheral neutrophil counts and neutrophil lymphocyte ratio in older individuals with COVID-19 disease. Together, our transcriptomic studies have delineated disease pathways that improve our understanding of the immunopathogenesis of COVID-19.