The Relationship Between Pan-Immune Inflammation Value and Mortality in Idiopathic Pulmonary Fibrosis

Abstract

Objectives: Idiopathic Pulmonary Fibrosis (IPF) is a progressive and potentially fatal interstitial lung disease of unknown origin etiology. Immunological and inflammatory pathways are central to its pathogenesis. The pan-immune inflammation value (PIV) is an emerging index that measures immune-inflammatory status through counts of platelets, neutrophils, monocytes, and lymphocytes. This study aimed to assess the prognostic significance of PIV in predicting disease outcomes and survival in IPF. Methods: IPF patients aged 18 years or older, followed from January 2016 to June 2024, were retrospectively analyzed. Patients with malignancy or hematologic disorders were excluded. PIV was determined at diagnosis, with patients divided into low- and high-PIV groups based on the median. Clinical, demographic, and laboratory data were compared, and the predictive value of PIV for survival was evaluated. Results: Among 142 patients, the median age was 70 years, the disease duration was 30 months, and the PIV was 302.8. Those with high PIV had a shorter disease duration (24 vs. 36 months, p=0.006) and higher rates of mortality, ICU admission, and nosocomial infections (p<0.05). The high PIV group showed increased troponin, white blood cell, neutrophil, monocyte, and platelet levels, along with decreased lymphocyte counts (p<0.05). Patients who died had shorter disease durations (22 months vs. 54 months, p<0.001) and more comorbidities, ICU admissions, and infections (p<0.05). LDH and PIV were higher, while magnesium was lower, in patients who died (p<0.05). Kaplan-Meier analysis showed that the median survival was 72 months for the low PIV group, whereas it was only 27 months for the high PIV group (p<0.01). Conclusion: A high PIV at diagnosis signals a worse outlook in IPF, highlighting the importance of inflammation in how the disease develops.

Keywords

• Idiopathic Pulmonary Fibrosis
• Survival
• Pan-Immune Inflammation Value

İdiyopatik Pulmoner Fibroziste Pan-İmmün İnflamasyon Değeri ile Mortalite Arasındaki İlişki

Abstract

Giriş: İdiyopatik Pulmoner Fibrozis (İPF); nedeni bilinmeyen, ilerleyici ve yaşamı tehdit eden bir interstisyel akciğer hastalığıdır. İmmünolojik ve inflamatuvar yolaklar, hastalığın gelişiminde merkezi bir rol oynamaktadır. Pan-immün inflamasyon değeri (PIV), trombosit, nötrofil, monosit ve lenfosit sayıları kullanılarak immün-inflamatuvar durumu değerlendiren yeni bir indekstir. Bu çalışma, İPF’de hastalık sonuçlarını ve sağkalımı öngörmede PIV’in prognostik önemini değerlendirmeyi amaçlamaktadır. Yöntemler: Ocak 2016 ile Haziran 2024 tarihleri arasında takip edilen, 18 yaş ve üzerindeki IPF hastaları retrospektif olarak incelendi. Malignite veya hematolojik hastalığı bulunan hastalar çalışma dışı bırakıldı. Tanı anındaki PIV değerleri hesaplandı ve hastalar, medyan PIV değerine göre düşük ve yüksek PIV gruplarına ayrıldı. Klinik, demografik ve laboratuvar verileri karşılaştırıldı ve PIV’in sağkalımı öngörme değeri değerlendirildi. Bulgular: Çalışmaya dâhil edilen 142 hastanın medyan yaşı 70 yıl, hastalık süresi 30 ay ve PIV değeri 302.8 idi. Yüksek PIV değerine sahip hastalarda hastalık süresi daha kısa (24 aya karşı 36 ay, p=0.006) ve mortalite, yoğun bakım yatışı ile nozokomiyal enfeksiyon oranları daha yüksek bulundu (p<0.05). Yüksek PIV grubunda troponin, beyaz kan hücresi, nötrofil, monosit ve trombosit düzeyleri artmış, lenfosit sayıları ise azalmıştı (p<0.05). Mortalite gelişen hastalarda hastalık süresi daha kısa (22 aya karşı 54 ay, p<0.001); komorbidite, yoğun bakım yatışı ve enfeksiyon oranları daha yüksekti (p<0.05). LDH ve PIV düzeyleri mortalite gelişen hastalarda daha yüksek, magnezyum düzeyi ise daha düşüktü (p<0.05). Kaplan-Meier analizinde, düşük PIV grubunda medyan sağkalım 72 ay iken yüksek PIV grubunda 27 ay olarak saptandı (p<0.01). Sonuç: Tanı anında yüksek PIV düzeyi, İPF’de kötü prognozu öngörmekte olup inflamasyonun hastalık progresyonundaki rolünü desteklemektedir.

Keywords

• İdiyopatik Pulmoner Fibrozis
• Sağkalım
• Pan-İmmün İnflamasyon Değeri

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