The Prognostic Role of Advanced Lung Cancer Inflammation Index in Patients with Idiopathic Pulmonary Fibrosis

Background: The advanced lung cancer inflammation index (ALI) is an innovative and thorough measure designed to assess both inflammation and nutritional status. It includes parameters such as albumin, body mass index (BMI), and the neutrophil-to-lymphocyte ratio (NLR). This research seeks to evaluate the prognosis of idiopathic pulmonary fibrosis (IPF) patients by integrating both inflammation and nutritional status, distinguishing it from conventional inflammation biomarkers. Methods: This study included 102 patients with IPF. Clinical data were extracted from the patients' medical records. NLR and ALI scores were calculated based on data collected at the initiation of antifibrotic treatment using the following formulas: Neut/Lym for NLR and albumin × BMI/NLR for ALI. Results: ALI values were assessed across various IPF patient subgroups based on gender-age-physiology (GAP) stages (1, 2, and 3), forced vital capacity (FVC) (median split: <70% vs. ≥70%), diffusing capacity for carbon monoxide (DLCO) (<51% vs. ≥51%), 6-Minute Walk Test (6MWT) (<350 vs. ≥350), and the Charlson comorbidity index (CCI) (≤1 vs. >1). Significant differences in ALI were observed with respect to GAP stages, FVC, DLCO, and 6MWT categories (p = 0.000 for all), but not for CCI categories (p = 0.233). Receiver operating characteristic (ROC) curve analysis revealed that ALI had a sensitivity of 63.6% and a specificity of 98.9% at a threshold of 11.2 (AUC = 0.945, 95% CI 0.892-0.998, p < 0.000). Conclusions: Our findings indicate that ALI levels are significantly associated with disease severity and mortality in IPF patients.