BackgroundScleroderma interstitial lung disease (SSc-ILD) has a variable and poorly predictable course. Data about the role of bronchoalveolar lavage fluid (BALF) analysis in prognostic stratification of SSc-ILD patients (pts) are conflicting.ObjectivesTo assess BALF analysis role in prognostic stratification of SSc-ILD pts.MethodsForty SSc-ILD pts naive to immunosuppressants underwent comprehensive clinical evaluation, BALF analysis with total and differential leukocyte count, pulmonaryfunction tests (PFTs), high-resolution computed tomography (HRCT) of the chest. All pts had fibrosing lung disease affecting more than 10% of lung volume on HRCT. Baseline alveolar and interstitial scores were computed. The 15-year crude mortality rate was retrospectively assessed.ResultsThe enrolled pts (male 20%, aged 53.9±13 years) had a disease duration of4.3±3.4 years. Diffuse cutaneous involvement LeRoy variant was present in 47.5% of pts, while anti-Scl70 and anti-centromere antibodies were detected in 57.5% and 12.5% of pts, respectively. The average alveolar and interstitial scores were 6.5±4.8 and 6.2±2.7, respectively; 25% of the pts had FVC less than or equal to 80% and 35% had DLco less than or equal to 80%. During the follow-up, 18 pts (45%) received immunosuppressants. BALF neutrophilia (> 3%), eosinophilia (>1%) and lymphocytosis (>15%) were reported in 40%, 16% and 5% of pts, respectively. Twenty-five pts (62.5%) died within 15 years after bronchoscopy. Fifteen-year mortality was predicted by neutrophilia (HR 5.5, 95% IC 1.9-15.7), log-transformed total cell count (HR 2.5, 95% IC 1.1-5.7), absolute neutrophil (HR 1.8, 95% IC 1.3-2.5) and eosinophil (HR 1.3, 95% IC 1.1-1-6) cell counts, and macrophage (HR 0.1, 95% IC 0-0.6), neutrophil (HR 1.9, 95% IC 1.3-2.7), and eosinophil (HR1.3, 95% IC 1-1.7) percentages. Only absolute and relative neutrophil counts were independently associated with mortality also in regression models adjusted for demographics (age, gender), main disease traits (diffuse cutaneous variant, anti-Scl70 positivity), pulmonary function tests (FVC, DLco), HRCT involvement (alveolar and interstitial scores) and vascular complications (presence of pulmonary hypertension, digital ulcers).ConclusionHigh BALF neutrophils were associated with high 15-year mortality independently from established clinical risk factors. BALF analysis could improve prognosis prediction in SSc-ILD pts.Disclosure of InterestsNone declared