Complete Blood Cell Count Parameters Predict Mortality in Patients with Hypersensitivity Pneumonitis

Matthaios Katsaras^{1

2}, Vasilina Sotiropoulou¹, Effrosyni Manali³, Evangelia Fouka⁴, Despoina Papakosta⁴, Elisabeth Bendstrup⁵, Lykourgos Kolilekas⁶, Ioannis Tomos^{3

7}, Vasilios Tzilas^{2

3}, Paschalis Ntolios⁸, Paschalis Steiropoulos⁸, Ilias Papanikolaou⁹, Athena Gogali¹⁰, Konstantinos Kostikas¹⁰, Panagiota Tsiri¹, Ourania Papaioannou¹, Elli Malakounidou¹, Eva Theohari¹, Ioannis Christopoulos¹, Fotios Sampsonas¹, Spyridon A Papiris³, Nikoletta Rovina², Demosthenes Bouros², Argyrios Tzouvelekis¹

Affiliations

¹ Department of Respiratory Medicine, University Hospital of Patras, 26500 Patras, Greece.
² 1st Respiratory Department, Sotiria Chest Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
³ 2nd Pulmonary Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
⁴ Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.
⁵ Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark.
⁶ 7th Pulmonary Department, Athens Chest Hospital "Sotiria", 11527 Athens, Greece.
⁷ 5th Pulmonary Department, Athens Chest Hospital "Sotiria", 11527 Athens, Greece.
⁸ Department of Respiratory Medicine, Medical School, University General Hospital Dragana, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
⁹ Pulmonary Department, Corfu General Hospital, 49100 Kontokali, Greece.
¹⁰ Department of Respiratory Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.

PMID: 40310410
PMCID: PMC12025666
DOI: 10.3390/diagnostics15081038

Complete Blood Cell Count Parameters Predict Mortality in Patients with Hypersensitivity Pneumonitis

Matthaios Katsaras et al. Diagnostics (Basel). 2025.

. 2025 Apr 18;15(8):1038.

doi: 10.3390/diagnostics15081038.

Authors

Affiliations

¹ Department of Respiratory Medicine, University Hospital of Patras, 26500 Patras, Greece.
² 1st Respiratory Department, Sotiria Chest Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
³ 2nd Pulmonary Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
⁴ Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.
⁵ Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark.
⁶ 7th Pulmonary Department, Athens Chest Hospital "Sotiria", 11527 Athens, Greece.
⁷ 5th Pulmonary Department, Athens Chest Hospital "Sotiria", 11527 Athens, Greece.
⁸ Department of Respiratory Medicine, Medical School, University General Hospital Dragana, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
⁹ Pulmonary Department, Corfu General Hospital, 49100 Kontokali, Greece.
¹⁰ Department of Respiratory Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.

PMID: 40310410
PMCID: PMC12025666
DOI: 10.3390/diagnostics15081038

Abstract

Background: Hypersensitivity pneumonitis (HP) represents a chronic lung disease with an unpredictable clinical course. There is a pressing need for clinically applicable prognostic biomarkers in patients with HP. Methods: This was an observational, retrospective study. We investigated the prognostic potential of complete blood count parameters in treatment-naïve patients diagnosed with HP between 15 December 2010 and 1 October 2023. Receiver operating characteristic (ROC) curve analysis identified the optimal cut-off thresholds for each parameter in terms of mortality prediction. Results: We included 129 patients diagnosed with HP [median age: 68.0 years (95% CI: 65.0 to 69.0), fibrotic HP: n = 85, 65.9%]. Patients with HP and an eosinophil count > 160 cells/μL [ROC curve, area under curve (AUC): 0.61] exhibited increased mortality risk compared to patients with HP and an eosinophil count ≤ 160 cells/μL [Kaplan-Meier, HR: 2.95 (95% CI: 1.36 to 6.42), p = 0.006]. Patients with HP and a monocyte count > 350 cells/μL (ROC curve, AUC: 0.52) had worse survival compared to patients with HP and a monocyte count lower than this threshold [Kaplan-Meier, HR: 2.48 (95% CI: 1.03 to 5.09), p = 0.04]. Patients with HP and an eosinophil-lymphocyte ratio (ELR) > 0.09 (ROC curve, AUC: 0.64) had a higher risk of mortality compared to patients with HP and ELR ≤ 0.09 [Kaplan-Meier, HR: 2.75 (95% CI: 1.3 to 5.78), p = 0.008]. Conclusions: This study demonstrated that eosinophil count, monocyte count, and ELR could be prognostic biomarkers in patients with HP. Further studies aiming to validate the prognostic potential of complete blood count parameters in patients with HP are greatly anticipated.

Keywords: biomarkers; eosinophil count; hypersensitivity pneumonitis; monocyte count.

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Conflict of interest statement

M.K., V.S., E.M., E.F., D.P., E.B., L.K., I.T., V.T., P.N., P.S., I.P., A.G., K.K., P.T., O.P., E.M., E.T., I.C., F.S., S.P., N.R., and D.B., declare no conflicts of interest. A.T. has received grants and honoraria from Boehringer Ingelheim, Hoffmann La Roche, Chiesi, Elpen, Astra Zeneca, GlaxoSmithKline, Menarini, Guidotti, Pfizer, Pliant, and Puretech outside of the submitted work.

Figures

**Figure 1**
Kaplan–Meier curve showing survival difference between patients with fibrotic (n = 85) and non-fibrotic (n = 44) HP [HR: 4.46 (95% CI: 2.08 to 9.57), p = 0.0001].

**Figure 2**
Kaplan–Meier curves showing survival differences according to complete blood count cell parameters. (A) Patients with high (n = 88) versus low (n = 41) eosinophil count with cut-off point > 160 cells/μL [HR: 2.95 (95% CI: 1.36 to 6.42), p = 0.006]. (B) Patients with high (n = 104) versus low (n = 25) monocyte count with cut-off point of 350 cells/μL [HR: 2.48 (95% CI: 1.03 to 5.09), p = 0.04]. (C) Patients with high (n = 30) versus low (n = 99) neutrophil count with cut-off point of 6010 cells/μL [HR: 2.09 (95% CI: 0.83 to 5.26), p = 0.12]. (D) Patients with high (n = 72) versus low (n = 57) lymphocyte count with cut-off point of 2050 cells/μL [HR: 1.47 (95% CI: 0.7 to 3.09), p = 0.32].

**Figure 3**
Kaplan–Meier curves showing survival differences according to blood cell ratios (A). Patients with high (n = 94) versus low (n = 35) eosinophil–monocyte ratio (EMR) with cut-off point of 0.27 [HR: 2.44 (95% CI: 1.08 to 5.51), p = 0.03]. (B). Patients with high (n = 75) versus low (n = 54) eosinophil–lymphocyte ratio (ELR) with cut-off point of 0.09 [HR: 2.75 (95% CI: 1.3 to 5.78), p = 0.008]. (C). Patients with high (n = 31) versus low (n = 98) neutrophil–lymphocyte ratio (NLR) with cut-off point of 2.73 [HR: 2.12 (95% CI: 0.84 to 5.34), p = 0.11].

**Figure 4**
(A) Eosinophil count (median, 95% CI) in patients with fibrotic (n = 85) vs. non-fibrotic (n = 44) HP [230 (95% CI: 200 to 280) vs. 200 (95% CI: 150 to 270), p = 0.04, Mann–Whitney test]. (B) Monocyte count (mean ± SD) in patients with fibrotic (n = 85) vs. non-fibrotic (n = 44) HP (561 ± 224 vs. 562 ± 228, p = 0.99, independent samples t-test).

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Complete Blood Cell Count Parameters Predict Mortality in Patients with Hypersensitivity Pneumonitis

Affiliations

Complete Blood Cell Count Parameters Predict Mortality in Patients with Hypersensitivity Pneumonitis

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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