Objectives Rapidly progressive interstitial lung disease (RPILD) is the most severe complication of anti-melanoma differentiation–associated gene 5–positive dermatomyositis (anti-MDA5-DM) and is relevant to poor prognosis. This retrospective study aimed to identify the clinical value of laboratory inflammatory and composite indices in patients with anti-MDA5-DM and determine their role in predicting the incidence of RPILD and disease prognosis. Methods In total, 51 patients with anti-MDA5-DM were retrospectively enrolled from July 2018 to April 2025. Patients were categorized into RPILD and non-RPILD subgroups (including those with stable ILD and without ILD), as well as survival and non-survival cohorts. Clinical and laboratory information was collected, and laboratory inflammatory and composite indices were calculated. Results In the RPILD group, levels of laboratory inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were higher than in the non-RPILD group, while lymphocyte-to-monocyte ratio (LMR) was lower (both P < 0.05). Composite indices such as albumin-to-alkaline phosphatase ratio (AAPR) and prognostic nutritional index (PNI) were lower in the RPILD group (both P < 0.05). The receiver operating characteristic (ROC) analysis demonstrated that a combination of SII, NLR, PIV, SIRI, and LMR yielded the highest predictive power for RPILD occurrence, with an area under the curve (AUC) of 77.21% (95% CI 0.6437–0.9009). For mortality prediction, LMR alone showed the best performance (AUC 73.93%, 95% CI 0.5876–0.8909). Spearman’s correlation analysis indicated that NLR exhibited a strong positive correlation with RPILD occurrence (r = 0.4343, 95% CI = 0.1722 to 0.6390) and all-cause mortality (r = − 0.3839, 95% CI = − 0.6011 to − 0.1119). Kaplan–Meier survival analysis further confirmed that elevated SII, PIV, and inflammatory burden index (IBI), as well as decreased LMR, hemoglobin, albumin, lymphocyte, platelet score (HALP), and AAPR, were significantly associated with poorer overall survival (all P < 0.05). To facilitate clinical translation, a nomogram predictive model was developed incorporating NLR and SIRI, which effectively estimated the probability of RPILD occurrence. Conclusion Readily available laboratory inflammatory and composite indices serve as practical and cost-effective biomarkers for predicting the incidence of RPILD and mortality in patients with anti-MDA5-DM. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> Key Points </entry> </row> <row> <entry align="left" colname="c1"> • Systematic evaluation of laboratory inflammatory and composite indices confirmed their significant association with disease severity in anti-MDA5-DM. • A novel nomogram integrating the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) effectively predicted the risk of rapidly progressive interstitial lung disease (RPILD), demonstrating good calibration and clinical utility. </entry> </row> </tbody> </tgroup> </Table>

The clinical values of laboratory inflammatory and composite indices in predicting rapidly progressive interstitial lung disease and prognosis in anti-MDA5 dermatomyositis patients

期刊论文
发表日期：

2026年1月15日

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Chenyi Yu,
Bin Liu,
Yating Liu,
Yifei Yuan,
Xiaerbate Zhakeerjiang,
Congbing Wei,
Li Zhang,
Bing Liu

摘要

Objectives

Rapidly progressive interstitial lung disease (RPILD) is the most severe complication of anti-melanoma differentiation–associated gene 5–positive dermatomyositis (anti-MDA5-DM) and is relevant to poor prognosis. This retrospective study aimed to identify the clinical value of laboratory inflammatory and composite indices in patients with anti-MDA5-DM and determine their role in predicting the incidence of RPILD and disease prognosis.

Methods

In total, 51 patients with anti-MDA5-DM were retrospectively enrolled from July 2018 to April 2025. Patients were categorized into RPILD and non-RPILD subgroups (including those with stable ILD and without ILD), as well as survival and non-survival cohorts. Clinical and laboratory information was collected, and laboratory inflammatory and composite indices were calculated.

Results

In the RPILD group, levels of laboratory inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were higher than in the non-RPILD group, while lymphocyte-to-monocyte ratio (LMR) was lower (both P < 0.05). Composite indices such as albumin-to-alkaline phosphatase ratio (AAPR) and prognostic nutritional index (PNI) were lower in the RPILD group (both P < 0.05). The receiver operating characteristic (ROC) analysis demonstrated that a combination of SII, NLR, PIV, SIRI, and LMR yielded the highest predictive power for RPILD occurrence, with an area under the curve (AUC) of 77.21% (95% CI 0.6437–0.9009). For mortality prediction, LMR alone showed the best performance (AUC 73.93%, 95% CI 0.5876–0.8909). Spearman’s correlation analysis indicated that NLR exhibited a strong positive correlation with RPILD occurrence (r = 0.4343, 95% CI = 0.1722 to 0.6390) and all-cause mortality (r = − 0.3839, 95% CI = − 0.6011 to − 0.1119). Kaplan–Meier survival analysis further confirmed that elevated SII, PIV, and inflammatory burden index (IBI), as well as decreased LMR, hemoglobin, albumin, lymphocyte, platelet score (HALP), and AAPR, were significantly associated with poorer overall survival (all P < 0.05). To facilitate clinical translation, a nomogram predictive model was developed incorporating NLR and SIRI, which effectively estimated the probability of RPILD occurrence.

Conclusion

Readily available laboratory inflammatory and composite indices serve as practical and cost-effective biomarkers for predicting the incidence of RPILD and mortality in patients with anti-MDA5-DM.

Key Points

• Systematic evaluation of laboratory inflammatory and composite indices confirmed their significant association with disease severity in anti-MDA5-DM.

• A novel nomogram integrating the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) effectively predicted the risk of rapidly progressive interstitial lung disease (RPILD), demonstrating good calibration and clinical utility.