TY - JOUR T1 - Increased monocyte level is a risk factor for radiological progression in patients with early fibrotic ILA JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00226-2022 SP - 00226-2022 AU - Andrew Achaiah AU - Paul Lyon AU - Emily Fraser AU - Peter Saunders AU - Rachel Hoyles AU - Rachel Benamore AU - Ling-Pei Ho Y1 - 2022/01/01 UR - http://openres.ersjournals.com/content/early/2022/05/13/23120541.00226-2022.abstract N2 - Background Interstitial lung abnormalities (ILA) are specific spatial patterns on computed tomography scan (CT), potentially compatible with early interstitial lung disease (ILD). A proportion will progress; management involves risk stratification and surveillance. Elevated blood monocyte levels have been shown to associate with progression of IPF.Aims To (i) estimate the proportion of “early fibrotic” ILAs (EF-ILA; reticular +/− ground glass opacities, excluding traction bronchiectasis and honeycombing) on CTs of patients attending all-indications thoracic CTs, and proportion demonstrating radiological progression and (ii) explore association between peripheral blood leukocyte levels and ILA progression.Methods We analysed all thoracic CT reports in individuals aged 45–75 performed between January-2015 and December-2020 in one large teaching hospital (Oxford, UK) to identify patient CT reports consistent with EF-ILA. CT-contemporaneous blood leukocyte counts were examined to explore contribution to progression and all-cause mortality, using multivariate Cox regression.Results 40 711 patients underwent thoracic CT imaging during this period. 1259 (3.1%) demonstrated the EF-ILA pattern. Mean age; 65.4 (±7.32), male; 735 (47.8%). EF-ILA was significantly associated with all-cause mortality [HR 1.87, 95%CI 1.25–2.78, p=0.002]. 362 cases underwent at least one follow-on CT. Radiological progression was observed in 157 cases (43.4%); increase in reticulation; 51, new traction bronchiectasis; 84, and honeycombing; 22. Monocyte count, neutrophil count, monocyte:lymphocyte ratio, neutrophil:lymphocyte ratio and 'systemic inflammatory response index' were significantly associated with radiological progression.Conclusion 3.1% of subjects requiring thoracic CT during a 6-year period demonstrated EF-ILA. Monocyte levels, and blood leukocyte-derived indexes were associated with radiological progression and could indicate which patients may require closer follow up.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Andrew Achaiah has nothing to disclose.Conflict of interest: Paul Lyon has nothing to disclose.Conflict of interest: Emily Fraser has nothing to disclose.Conflict of interest: Rachel Benamore has nothing to disclose.Conflict of interest: Ling-Pei Ho has nothing to disclose.Conflict of interest: Rachel Hoyles has nothing to disclose.Conflict of interest: Peter Saunders has received consultancy fees from Trevi Therapeutics, and lecture fees from Boehringer Ingelheim, but no other conflict of interest. ER -