Introduction: Combined pulmonary fibrosis and emphysema (CPFE) is relatively common in patients with idiopathic pulmonary fibrosis (IPF). The prognostic biomarkers of CPFE is not clear.

Aim: We will assess the serum neutrophil-lymphocyte ratio (NLR), monocyte counts and eosinophils in patients with CPFE compared with COPD or IPF without overlap. 

Methods: Between 2012.1 and 2022.5, the patients with the clinical diagnosis of IPF, CPFE and COPD were enrolled. The demographic, clinical characteristics and serum biomarkers of the patients at baseline were recorded for analysis.

Results: A total of 213 patients, including 69 IPF, 63 CPFE and 81 COPD patients were included. The long-term survival of IPF and CPFE was similar (p=0.716), which was significant shorter than COPD cohort (p<0.001). In IPF and CPFE cohort, the univariant analysis showed that high NLR >3.0 (p=0.002), patients with usual interstitial pneumonia (UIP) pattern (p=0.001), fibrotic area >10% (p<0.001), patients with lung cancer (p=0.002) and without antifibrotic agents (Nintedanib or Pirfenidone) exposure (p<0.001) were associated with higher mortality. After adjusting for confounders, we found that elevated NLR [Hazard Ratio (HR):2.002, P=0.043] and fibrotic area >10% (HR:3.752, P=0.033) were associated with worse survival. Patients exposure to antifibrotic agents was independent factor associated better survival (HR:0.302, P=0.002). No significant differences were found in monocyte counts (>600) or blood eosinophils (>300) associated with survival.

Conclusion: High NLR and extent of fibrosis area are associated with worse survival in IPF/CPFE.