European Respiratory Journal最新文献

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Physiological quotients and mortality: redefining lung function interpretation beyond FEV1. 生理商和死亡率：重新定义肺功能的解释，超越FEV1。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.02204-2025

Ben Knox-Brown,Lucy Robertson,Andre F S Amaral,Karl P Sylvester

BACKGROUNDThe FEV1Q is a physiological quotient reflecting the distance a measured FEV1 is from a 1st percentile (minimally survivable) value. We aimed to derive physiological quotients for other lung function measures and assess their association with all-cause mortality.METHODSWe analysed data from adults referred for lung function testing at Cambridge University Hospital (CUH) and Royal Papworth Hospital (RPH) between 2016 and 2024. We investigated the stability of the 1st percentiles for FEV1, FVC, FEV1/FVC, DLCO, KCO, VA, and TLC stratified by sex and age group by visualising the overlap of 95% confidence intervals. We calculated physiological quotients for each parameter (measured value/1st percentile) and investigated their association with all-cause mortality using Cox regression analysis. We used Harrell's C statistics to compare discriminative performance.RESULTSWe analysed data from 7717 CUH patients and 6054 RPH patients. At CUH, 51% were female, compared to 45% at RPH. Mean age was 57.9 (sd 14.9) years at CUH and 62.7 (sd 14.8) at RPH. 1st percentile values were generally consistent across age groups but different for males and females for FEV1, FVC, VA, and TLC. For FEV1/FVC, DLCO, and KCO 1st percentile values were generally stable across both age and sex. Mean follow-up times were 5.8 (sd 2.6) years at CUH and 5.5 (sd 2.7) years at RPH, during which time 19% and 39% of patients died respectively. Physiological quotients had higher Harrell's C statistics, indicating better discrimination of survival than lung function expressed as raw units, z-scores and percent predicted.CONCLUSIONPhysiological quotients have greater discriminative ability in the prediction of all-cause mortality than existing metrics, providing an alternative standard for lung function interpretation.

FEV1Q是一个生理商，反映了测量到的FEV1与第一个百分位数（最低生存能力）值的距离。我们的目的是得出其他肺功能测量的生理商数，并评估它们与全因死亡率的关系。方法：我们分析了2016年至2024年间在剑桥大学医院（CUH）和皇家帕普沃斯医院（RPH）转诊的成人肺功能检测数据。我们通过可视化95%置信区间的重叠来研究FEV1、FVC、FEV1/FVC、DLCO、KCO、VA和TLC按性别和年龄组分层的第一个百分位数的稳定性。我们计算了每个参数的生理商（测量值/第一个百分位数），并使用Cox回归分析调查了它们与全因死亡率的关系。我们使用Harrell的C统计来比较判别性能。结果我们分析了7717例CUH患者和6054例RPH患者的数据。在CUH， 51%是女性，而在RPH是45%。CUH的平均年龄为57.9岁（sd 14.9）， RPH的平均年龄为62.7岁（sd 14.8）。FEV1、FVC、VA和TLC的第一百分位数在各年龄组中基本一致，但在男性和女性中有所不同。对于FEV1/FVC， DLCO和KCO的第一个百分位数在年龄和性别上都是稳定的。CUH组和RPH组的平均随访时间分别为5.8 （sd 2.6）年和5.5 （sd 2.7）年，在此期间分别有19%和39%的患者死亡。生理商具有更高的Harrell’s C统计值，表明比以原始单位、z分数和预测百分比表示的肺功能更好地区分生存。结论生理商在预测全因死亡率方面比现有指标具有更强的判别能力，为肺功能解释提供了另一种标准。

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引用次数: 0

Early origins of chronic lung diseases: bronchiectasis takes the lead. 慢性肺部疾病的早期起源：支气管扩张症居首。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.01859-2025

Oleksandr Mazulov

引用次数: 0

Prognostic value of disease severity and mechanical ventilation intensity in acute respiratory distress syndrome: analysis of the LUNG SAFE cohort. 急性呼吸窘迫综合征患者病情严重程度和机械通气强度的预后价值。LUNG SAFE队列分析。

IF 21 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 Print Date: 2026-01-01 DOI: 10.1183/13993003.00742-2025

Emanuele Rezoagli, John G Laffey, Fabiana Madotto, Alessandro Protti, Tai Pham, Antonio Pesenti, Giacomo Bellani, Laurent Brochard

Background: We aimed to assess the prognostic performance of different indexes of oxygenation, respiratory mechanics and ventilation intensity in predicting 90-day mortality, and to estimate their independent associations, in a "real-world" observational cohort of acute respiratory distress syndrome (ARDS) patients on intensive care unit (ICU) mortality.

Methods: This is a secondary analysis of LUNG SAFE (Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE), an international prospective cohort study of patients with severe respiratory failure involving 459 ICUs from 50 countries. We evaluated the prognostic performance of oxygenation (arterial oxygen tension (P _aO₂ )/inspiratory oxygen fraction (F _IO₂ )), respiratory mechanics (normalised elastance) and ventilation intensity (plateau pressure (P _plat), driving pressure (DP), 4DP+respiratory rate (RR) and mechanical power (MP)) measured on day 1 of controlled mechanical ventilation in ARDS patients, with respect to ICU mortality within 90 days of admission. For each parameter, associations with mortality were assessed using logistic regression models, estimating effect sizes (odds ratios with 95% confidence interval), model discrimination (area under the receiver operating characteristic curve), calibration and overall predictive accuracy.

Results: Among 2813 early ARDS patients, 516 (18.3%) met the inclusion criteria: mean±sd age 60±16 years, 61% male. Normalised elastance, P _plat, DP and 4DP+RR were significantly associated with mortality, with adjusted ORs ranging from 1.02 (95% CI 1.01-1.03) for 4DP+RR to 1.48 (95% CI 1.15-1.95) for normalised elastance. These parameters showed higher predictive accuracy for mortality compared with P _aO₂ /F _IO₂ and MP. MP showed a U-shaped relationship with mortality but was not significantly associated with it. Its predictive accuracy decreased after accounting for positive end-expiratory pressure (PEEP) and dynamic resistance, with PEEP also demonstrating a U-shaped association with mortality.

Conclusions: Normalised elastance, DP and 4DP+RR, measured at day 1 of ARDS, were the best predictors of ICU mortality, and outperformed oxygenation and MP. DP showed the best balance between predictive accuracy and clinical simplicity. These results reinforce the importance of focusing on DP and 4DP+RR as key metrics to guide lung-protective strategies and ARDS severity classification.

背景：我们旨在评估氧合、呼吸力学和通气强度等不同指标在预测90天死亡率中的预后表现，并在“真实世界”急性呼吸窘迫综合征（ARDS）患者ICU死亡率的观察队列中估计它们的独立相关性。方法：这是对“了解严重急性呼吸衰竭全球影响的大型观察性研究”（LUNG SAFE）的二级分析，该研究是一项国际前瞻性队列研究，涉及来自50个国家的459个重症监护病房（icu）的严重呼吸衰竭患者。我们评估了氧合（PaO2/FiO2）、呼吸力学（归一化弹性）和通气强度（平台压力、驱动压力（DP））的预后表现；4DP+RR和机械功率（MP）)在ARDS患者控制机械通气第1天测量，相对于入院90天内ICU死亡率。对于每个参数，使用逻辑回归模型评估与死亡率的关联，估计效应大小（优势比，OR 95%置信区间，CI），模型判别（ROC曲线下面积），校准和总体预测准确性。结果：2813例早期ARDS患者中，516例（18.3%）符合纳入标准：平均年龄60岁（±16岁），61%为男性。归一化弹性、平台、DP和4DP+RR与死亡率显著相关，调整后的or范围从4DP+RR的1.02 （95%CI 1.01-1.03）到归一化弹性的1.48 （95%CI 1.15-1.95）。与PaO2/FiO2和MP相比，这些参数对死亡率的预测准确性更高。MP与死亡率呈u型关系，但相关性不显著。在考虑了呼气末正压（PEEP）和动态阻力后，其预测准确性下降，PEEP也与死亡率呈u型相关。结论：标准化弹性、DP和4DP+ rr （ards第1天测量）是ICU死亡率的最佳预测指标，优于氧合和MP。DP在预测准确性和临床简洁性之间取得了最好的平衡。这些结果强化了关注DP和4DP+RR作为指导肺保护策略和ARDS严重程度分级的关键指标的重要性。

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引用次数: 0

Optimal dosing and duration of linezolid in multidrug-resistant tuberculosis: methodological and clinical appraisal. 利奈唑胺治疗耐多药结核病的最佳剂量和持续时间：方法学和临床评价。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.01804-2025

Weiliang Cao

引用次数: 0

Saliva point-of-care testing for suboptimal levofloxacin and linezolid exposure in multidrug-resistant tuberculosis. 唾液护理点检测耐多药结核病患者左氧氟沙星和利奈唑胺暴露情况。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.01875-2025

Thi A Nguyen,Anh T Nguyen,Luong V Dinh,Hoa B Nguyen,Hoa D Vu,Tram N B Nguyen,Dang Vu,Nieko C Punt,Greg J Fox,Sophie L Stocker,Jan-Willem C Alffenaar

BACKGROUNDTherapeutic drug monitoring may optimise treatment outcomes in patients with multidrug-resistant tuberculosis, yet current methods are invasive and resource-intensive. This study evaluated the feasibility of using saliva point-of-care testing to screen for suboptimal exposure to levofloxacin and linezolid.METHODSWe conducted a community-based cross-sectional study in Vietnam (2021-2023). Drug concentrations were measured in paired plasma and saliva samples at 0, 2 and 5 h post dose, using a point-of-care test (NanoPhotometer®) in comparison with liquid chromatography mass spectrometry. Drug exposure (area under the curve from 0 to 24 h) was calculated using Bayesian population pharmacokinetic approach (Edsim++). Therapeutic targets were defined as a free area under the curve to minimum inhibitory concentration ratio of 160 for levofloxacin and 125 for linezolid. Receiver operating characteristic curve analyses were conducted to determine optimal saliva thresholds for predicting sub- or supra-therapeutic plasma exposure.RESULTSA saliva exposure threshold of 70.3 mg·h·L-1 accurately identified 16 of 19 patients with subtherapeutic levofloxacin plasma exposure (sensitivity 84%, specificity 78%, N=60). For linezolid (N=17), saliva testing correctly identified the only patient with subtherapeutic exposure and the only one with supratherapeutic exposure. However, no saliva exposure thresholds could be determined.CONCLUSIONSSaliva-based point-of-care testing may predict the plasma drug exposure of levofloxacin and linezolid, and thus enabling the detection of patients at risk of suboptimal drug exposure. This non-invasive tool warrants further investigation to establish saliva-based threshold for linezolid and to evaluate clinical impact and cost-effectiveness of saliva-guided drug dosing.

背景：治疗性药物监测可以优化耐多药结核病患者的治疗结果，但目前的方法是侵入性的和资源密集型的。本研究评估了使用唾液即时检测筛查左氧氟沙星和利奈唑胺次优暴露的可行性。方法：我们在越南进行了一项基于社区的横断面研究（2021-2023）。使用即时检测（NanoPhotometer®）与液相色谱-质谱法比较，在给药后0,2和5小时测量配对血浆和唾液样品中的药物浓度。采用贝叶斯群体药代动力学方法（Edsim++）计算药物暴露量（0 ~ 24 h曲线下面积）。治疗靶点定义为曲线下的自由区域，最小抑制浓度比左氧氟沙星为160，利奈唑胺为125。进行受试者工作特征曲线分析，以确定预测亚治疗或超治疗血浆暴露的最佳唾液阈值。结果唾液暴露阈值为70.3 mg·h·L-1，能准确鉴别19例左氧氟沙星亚治疗血浆暴露患者中的16例（敏感性84%，特异性78%，N=60）。对于利奈唑胺（N=17），唾液检测正确地识别了唯一的亚治疗暴露患者和唯一的超治疗暴露患者。然而，无法确定唾液暴露阈值。结论基于唾液的护理点检测可预测血浆左氧氟沙星和利奈唑胺的药物暴露，从而发现存在亚理想药物暴露风险的患者。这种非侵入性工具值得进一步研究，以建立基于唾液的利奈唑胺阈值，并评估唾液引导给药的临床影响和成本效益。

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引用次数: 0

Long-term safety and tolerability of frespaciguat: the INSIGNIA-PAH extension. 长期安全性和耐受性：INSIGNIA-PAH扩展。

IF 21 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 Print Date: 2026-01-01 DOI: 10.1183/13993003.01459-2025

Marc Humbert, Paul M Hassoun, Kelly M Chin, Guillermo Bortman, Humberto Garcia-Aguilar, Carmen La Rosa, Mackenzie Ford, Wei Fu, PoYao Niu, Maria José Loureiro, Marius M Hoeper

引用次数: 0

Reply to: Optimal dosing and duration of linezolid in multidrug-resistant tuberculosis: methodological and clinical appraisal. 答复：利奈唑胺治疗耐多药结核病的最佳剂量和持续时间：方法学和临床评价。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.02064-2025

Nakwon Kwak,Joong-Yub Kim,Areum Han,Seokyung Hahn,Jae-Joon Yim

引用次数: 0

sST2 and IL-6 predict prognosis of medically treated chronic thromboembolic pulmonary hypertension. sST2和IL-6可预测经药物治疗的慢性血栓栓塞性肺动脉高压的预后。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.02367-2025

Chao Liu,Bao-Chen Qiu,Shuang-Ping Li,Jing-Si Ma,Meng-Yi Liu,Si-Jin Zhang,Xi-Jie Zhu,Yin-Jian Yang,Tian-Yu Lian,Ying-Ying Cheng,Hui-Hui Xu,Yu-Ping Zhou,Jing-Hui Li,Wen-Hui Wu,Xi-Qi Xu,Yi-Min Mao,Chun-Yan Cheng,Xin Jiang,Kai Sun,Ze-Jian Zhang,Zhi-Cheng Jing

BACKGROUNDSAccurate risk stratification is crucial for guiding therapy in medically treated chronic thromboembolic pulmonary hypertension (CTEPH), where inflammation plays a key pathogenic role. This study aimed to identify and validate prognostic inflammatory biomarkers in medically treated CTEPH, with the goal of refining risk assessment and improving clinical management.METHODSThis dual-cohort study enrolled 576 medically treated CTEPH patients (discovery: 372; validation: 204) from 2009-2021. Plasma levels of inflammatory biomarkers, including soluble suppression tumorigenicity 2 (sST2), Galectin-3, and a panel of cytokines were measured in all participants. The study endpoint was all-cause mortality. The prognostic significance of inflammatory markers was evaluated using Kaplan-Meier survival analysis, Cox regression models, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).RESULTSPlasma sST2 and interleukin-6 (IL-6) were identified as predictors of survival, and remained robust predictors of mortality after comprehensive adjustment for clinical covariates in both cohorts. Risk stratification using the sST2/IL-6 panel revealed distinct 5-year survival gradients: high sST2/high IL-6 (34.4%), low sST2/high IL-6 (61.4%), high sST2/low IL-6 (78.3%), and low sST2/low IL-6 (90.5%) in the discovery cohort (p<0.001), with consistent validation. Furthermore, integrating the sST2/IL-6 panel with existing risk models (COMPERA, COMPERA 2.0, FPHN invasive, FPHN noninvasive, and REVEAL2.0) significantly enhanced their prognostic discriminatory power, as evidenced by increased C-indexes, NRI and IDI in both cohorts.CONCLUSIONSsST2 and IL-6 are independent prognostic biomarkers in medically treated CTEPH. Their combined use enhances risk stratification and adds incremental value to existing risk models.

准确的风险分层对于指导医学治疗慢性血栓栓塞性肺动脉高压（CTEPH）的治疗至关重要，炎症在CTEPH中起着关键的致病作用。本研究旨在识别和验证药物治疗CTEPH的预后炎症生物标志物，以完善风险评估和改善临床管理。方法本双队列研究纳入了2009-2021年间576例接受过药物治疗的CTEPH患者（发现：372例；验证：204例）。在所有参与者中测量炎症生物标志物的血浆水平，包括可溶性抑制致瘤性2 （sST2）、半乳糖凝集素-3和一组细胞因子。研究终点为全因死亡率。采用Kaplan-Meier生存分析、Cox回归模型、c指数、净重分类改善（NRI）和综合判别改善（IDI）评估炎症标志物的预后意义。结果血浆sST2和白细胞介素-6 （IL-6）被确定为生存的预测因子，并且在对两个队列的临床协变量进行综合调整后仍然是死亡率的可靠预测因子。使用sST2/IL-6面板的风险分层显示了不同的5年生存梯度：在发现队列中，高sST2/高IL-6(34.4%)，低sST2/高IL-6(61.4%)，高sST2/低IL-6（78.3%）和低sST2/低IL-6(90.5%)，验证一致（p<0.001）。此外，将sST2/IL-6面板与现有的风险模型（COMPERA、COMPERA 2.0、FPHN有创、FPHN无创和REVEAL2.0）整合，显著增强了它们的预后区分能力，两个队列的c指数、NRI和IDI均有所增加。结论ssst2和IL-6是药物治疗CTEPH的独立预后生物标志物。它们的联合使用增强了风险分层，并为现有风险模型增加了增量价值。

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引用次数: 0

Serum ferritin trajectories predict mortality risk in anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis: a longitudinal cohort study. 血清铁蛋白轨迹预测抗黑色素瘤分化相关蛋白5抗体阳性皮肌炎患者的死亡风险：一项纵向队列研究

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.01802-2025

Yingfang Zhang,Xinyao Lai,Jiang Li,Shiyu Wu,Xinxin Zhang,Chao Sun,Longyang Zhu,Linrong He,Yu Zuo,Wei Jiang,Guangtao Li,Xiaoming Shu

引用次数: 0

AI-powered analysis of bronchiectasis research trends: methodological considerations. 支气管扩张研究趋势的人工智能分析：方法学考虑。

IF 24.3 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Journal

Pub Date : 2026-01-22 DOI: 10.1183/13993003.01843-2025

Zekai Yu

引用次数: 0

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