Clinical Analysis of Peripheral Blood Indicators for Immune-Related Adverse Events (irAEs) in Patients With Advanced Lung Cancer

Background: Immune checkpoint inhibitors (ICIs) have revolutionized advanced lung cancer treatment, but immune-related adverse events (irAEs) remain a significant challenge. This study aimed to identify peripheral blood indicators associated with Immune-Related Adverse Events (irAEs) to improve early prediction and management. Methods: A retrospective analysis of 1910 advanced lung cancer cases treated with ICIs (2015-2024) was conducted. Patients were categorized into 2 groups: irAEs (n = 323) and control (n = 323). Peripheral blood indicators were analyzed at baseline and during treatment. Statistical analyses included t-tests, Mann-Whitney U tests, logistic regression, and Cox proportional hazards models. Results: Age (odds ratio [OR] = 0.96, P < .001) and radiotherapy history (OR = 2.35, P = .004) were significant irAE risk factors. Hemoglobin, red blood cells, and lymphocyte ratios decreased, while neutrophil ratios, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), and systemic inflammation markers increased in irAE patients. The NLR and LDH were independent predictors of irAEs and overall survival (P < .05). Conclusion: Peripheral blood indicators are valuable for irAE prediction. Specifically, elevated NLR (hazard ratio [HR] = 1.14, P = .002) and LDH (HR = 1.00, P = .03) were identified as independent risk factors for irAEs and were also significantly associated with poorer overall survival.