Respiratory medicine最新文献_第2页

Clinical impact of pre-determined guideline selection for the diagnosis of fibrotic hypersensitivity pneumonitis 预先确定指南选择对纤维化超敏性肺炎诊断的临床影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107925

Pedro Magalhães Ferreira , Francisco Machado , David Barros Coelho , André Terras Alexandre , Hélder Novais Bastos , Patrícia Mota , Natália Melo , Susana Guimarães , Conceição Souto-Moura , André Carvalho , António Morais

Introduction and objectives

International guidelines for the diagnosis of Hypersensitivity Pneumonitis (HP) have improved the diagnostic standardization of this heterogeneous interstitial lung disease. Our goal was to determine how the final multidisciplinary discussion confidence level for suspected fibrotic HP (fHP) can be impacted by the application of different guidelines validated in this context.

Materials and methods

Retrospective study including patients submitted to transbronchial lung cryobiopsy (TBLC) with a final multidisciplinary meeting diagnosis of fHP. Both guidelines were applied to all patients in a stepwise fashion and directly compared according to the level of confidence in a fHP diagnosis.

Results

A total of 170 patients were diagnosed with fHP after TBLC and subsequent multidisciplinary discussion. Overall, there was a statistically significant change in proportion towards higher confidence diagnostic levels using the CHEST guideline (p < 0.0001). Changes were significant at three different levels: ATS/JRS/ALAT's “fHP not excluded” subgroup significantly upscaled to CHEST's “provisional low-confidence” subgroup (76.2 % increase; p < 0.001) and the proportion of patients in ATS/JRS/ALAT's “low confidence” subgroup significantly upscaled to both CHEST's “provisional high-confidence” (67.4 % increase; p < 0.001) and “definitive fHP” (50 % increase; p < 0.001) subgroups. The alternative application of the CHEST guideline in multidisciplinary discussion would have resulted in 73 less TBLC (42.9 % decrease versus the ATS/JRS/ALAT-oriented decision).

Conclusions

This study suggests a significant increase in definite fHP diagnosis when applying the CHEST versus the ATS/JRS/ALAT guideline, resulting in almost a 43 % decrease in referrals to TBLC when compared with the latter due to a combination of less strict radiological criteria and a more prominent role of BAL.

简介和目的：超敏性肺炎（HP）的国际诊断指南提高了这种异质性间质性肺疾病的诊断标准化。我们的目标是确定在这种情况下，不同指南的应用如何影响疑似纤维化HP （fHP）的最终多学科讨论置信水平。材料和方法：回顾性研究包括经支气管肺低温活检（TBLC）最终多学科会议诊断为fHP的患者。两种指南以逐步方式应用于所有患者，并根据fHP诊断的置信度直接进行比较。结果：共有170例患者在TBLC和随后的多学科讨论后被诊断为fHP。总体而言，使用CHEST指南获得更高置信度诊断水平的比例有统计学意义上的显著变化(结论：本研究表明，与ATS/JRS/ALAT指南相比，使用CHEST指南确诊fHP的比例显著增加，与后者相比，由于放射学标准不那么严格，BAL的作用更突出，因此转诊TBLC的人数减少了近43%。

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引用次数: 0

The minimally important difference in the six-minute walk test predicts clinical worsening in pulmonary arterial hypertension 6分钟步行试验的最小重要差异预测肺动脉高压的临床恶化。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107919

Arsal Tharwani , Omar Minai , Youlan Rao , Hyoshin Kim , Gustavo A. Heresi

Background

The minimally important difference (MID) in the 6-min walk test (6MWT) for pulmonary arterial hypertension (PAH) is estimated to be 33 m using distributional and anchor-based methods. Quality of life was used as the anchor. Here, we sought to determine whether the MID is predictive of clinical worsening.

Methods

This was a post hoc analysis of the pivotal clinical trial of tadalafil in PAH (n = 405) and its extension phase (n = 161). The 6MWT was determined at the end of the placebo-controlled phase of 16 weeks and dichotomized as < 33 or ≥33 m. Primary outcome was clinical worsening ascertained at 16 weeks and at 68 weeks of follow up. Cox proportional hazard analysis was used to determine the association between 6MWT and clinical worsening.

Results

Mean age for patients in the pivotal trial of tadalafil was 54 years old ( ± 15.5 yrs). There were 317 (78.3 %) female patients and 61 % with idiopathic PAH. 53 % of the patients were on background bosentan therapy. A 6MWT <33 m was associated with an increased risk of clinical worsening at 16 and 68 weeks. These results were unchanged after adjusting for age, sex, background therapy with bosentan, and tadalafil dose. There were no PAH hospitalizations during short-term and long-term follow up in patients achieving a 6MWT ≥33 m

Conclusions

The 6MWT MID of 33 m is predictive of short- and long-term clinical worsening. These results further validate 33 m as a relevant MID for the 6MWT.

背景：根据分布和锚定方法，肺动脉高压（PAH） 6分钟步行试验（6MWT）的最小重要差异（MID）估计为33米。生活质量被用作锚点。在这里，我们试图确定MID是否可以预测临床恶化。方法：这是一项他达拉非治疗PAH （n = 405）及其延长期（n = 161）的关键临床试验的事后分析。在安慰剂对照期16周结束时测定6MWT，并将其分为< 33米或≥33米。主要结局是在随访16周和68周时确定临床恶化。采用Cox比例风险分析确定6MWT与临床恶化之间的关系。结果：他达拉非关键试验患者的平均年龄为54岁（+/-15.5岁）。317例（78.3%）女性患者，61%为特发性PAH。53%的患者接受了波生坦背景治疗。6MWT < 33米与16周和68周临床恶化的风险增加相关。在调整了年龄、性别、波生坦背景治疗和他达拉非剂量后，这些结果没有变化。6MWT≥33米的患者在短期和长期随访期间均无PAH住院。结论：33米的6MWT MID可预测短期和长期的临床恶化。这些结果进一步验证了33米是6MWT的相关MID。

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引用次数: 0

Serum cholesterol levels predict the survival in patients with idiopathic pulmonary fibrosis: A long-term follow up study 血清胆固醇水平可预测特发性肺纤维化患者的存活率：长期随访研究

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107937

Ranxun Chen, Guanning Zhong, Tong Ji, Qinghua Xu, Huarui Liu, Qingqing Xu, Lulu Chen, Jinghong Dai

Background

The relationship between serum lipid with idiopathic pulmonary fibrosis (IPF) required to be explored. We aim to evaluate the association of serum lipid levels with mortality in patients with IPF.

Materials and methods

This retrospective study included IPF patients with more than three years follow-up. We collected baseline demographics information, forced vital capacity (FVC)% predicted, carbon monoxide diffusion capacity (DLCO)% predicted, gender-age-physiology (GAP) index, and serum lipid levels, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). We evaluate the relationship between the serum lipid levels and the disease severity, and the mortality in IPF.

Results

This study enrolled 146 patients, with the three-year survival rate of 71.23 %. The median follow-up time was 46.5 months. There was no significant difference in baseline lipid levels between the survival and non-survival group. TG levels were positively correlated with DLCO% predicted (r = 0.189, p = 0.022) and negatively correlated with GAP index (r = −0.186, p = 0.025). After adjusting for GAP index, smoking history, body mass index and the use of antifibrotic and lipid-lowering drug, lower TC levels (HR: 0.74, 95 % CI: 0.58–0.94, p = 0.013) were identified as an independent risk factor for mortality.

Conclusion

This study demonstrated that lower TC levels were associated with increased mortality in IPF. More investigations are required to explore the role of lipid metabolism in the pathogenesis of pulmonary fibrosis.

背景：血脂与特发性肺纤维化（IPF）的关系有待探讨。我们的目的是评估血脂水平与IPF患者死亡率的关系。材料与方法：回顾性研究纳入IPF患者，随访3年以上。我们收集了基线人口统计信息、预测的强制肺活量（FVC）%、预测的一氧化碳扩散能力（DLCO）%、性别-年龄-生理（GAP）指数和血脂水平，包括甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）。我们评估了血脂水平与IPF患者病情严重程度及死亡率之间的关系。结果：本研究纳入146例患者，3年生存率为71.23%。中位随访时间为46.5个月。在生存组和非生存组之间，基线脂质水平没有显著差异。TG水平与DLCO%预测值呈正相关（r= 0.189, p= 0.022），与GAP指数呈负相关（r=-0.186, p=0.025）。在调整GAP指数、吸烟史、体重指数和使用抗纤维化和降脂药物后，较低的TC水平（HR: 0.74, 95% CI: 0.58-0.94, p=0.013）被确定为死亡率的独立危险因素。结论：本研究表明，较低的TC水平与IPF死亡率增加有关。脂质代谢在肺纤维化发病机制中的作用有待进一步研究。

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引用次数: 0

Clinically significant hemoptysis and all-cause mortality in patients with nontuberculous mycobacterial pulmonary disease 非结核性分枝杆菌肺病患者的临床显著咯血和全因死亡率

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2025.107946

Kwonhyung Hyung , Sung A Kim , Nakwon Kwak , Jae-Joon Yim , Joong-Yub Kim

Background

Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.

Methods

Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis—defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection—and its association with all-cause mortality.

Results

Among 506 patients from the ongoing cohort, 43 patients (8.5 %) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95 % confidence interval [CI]; 1.5–2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95 % CI, 1.02–3.60), higher C-reactive protein (CRP) (IRR, 1.20 for 1 mg/dl increase; 95 % CI, 1.01–1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10 % increase; 95 % CI, 0.66–0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95 % CI, 1.31–4.36).

Conclusion

In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.

Clinical trial registration

ClinicalTrials.gov; No.: NCT01616745.

背景：咯血是非结核性分枝杆菌肺病（NTM-PD）患者的主要症状之一。然而，其患病率、发病率和对长期预后的影响仍不确定。我们评估了临床显著咯血的发生率，并确定了其与NTM-PD患者死亡率的关系。方法：对2011年7月至2023年5月纳入前瞻性观察队列（NCT01616745）的患者进行分析。我们评估了临床上明显咯血的危险因素——定义为需要支气管动脉栓塞或手术切除等干预措施的咯血事件——及其与全因死亡率的关系。结果：在正在进行的队列中的506名患者中，43名患者（8.5%）在中位随访5.1年期间出现临床显著咯血。临床显著咯血的总发生率为2.1(95%可信区间[CI]；每100人年1.5-2.9例。确定的危险因素包括结核病史(发病率比[IRR]， 1.91；95% CI, 1.02-3.60)，升高的c反应蛋白（CRP） (IRR， 1mg/dl升高1.20；95% CI, 1.01-1.43)，预测强迫肺活量（FVC）的百分比更低（IRR, 0.81）；95% ci, 0.66-0.98)。临床显著咯血与全因死亡风险增加独立相关(校正风险比，2.39；95% ci, 1.31-4.36)。结论：在NTM-PD患者中，有结核病史、CRP水平较高、FVC预测值较低的患者发生临床显著咯血的风险较高。重要的是，临床上显著的咯血与全因死亡风险升高相关。临床试验注册：ClinicalTrials.gov；否。: NCT01616745。

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引用次数: 0

Association of interstitial lung abnormalities with cytotoxic agent-induced pneumonitis in patients with malignancy 恶性肿瘤患者肺间质异常与细胞毒性药物引起的肺炎的关系。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107924

Kyohei Oishi , Hironao Hozumi , Nobuko Yoshizawa , Shintaro Ichikawa , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Masato Karayama , Kazuki Furuhashi , Noriyuki Enomoto , Tomoyuki Fujisawa , Satoshi Goshima , Naoki Inui , Takafumi Suda

Background and objective

The association between interstitial lung abnormalities (ILA) and various conditions and diseases, including drug-related pneumonitis (DRP), has been reported. However, the association of the presence of ILA with developing DRP in patients undergoing cytotoxic agent-based chemotherapy, one of the standard treatments for malignancies, remains unclear. This warrants urgent investigation.

Methods

We included consecutive patients diagnosed with malignancy and treated with cytotoxic agents with/without immune checkpoint inhibitors (ICIs). We used Gray's method and multivariate Fine-Gray sub-distribution hazards analysis to evaluate the cumulative incidence of DRP (common terminology criteria for adverse events grade of ≥3) and the association between ILA and DRP development, respectively.

Results

Among 786 patients, 58 (7.3 %) demonstrated ILA. Patients with ILA were older, predominantly male, and reported a higher smoking history compared to those without ILA. The 90-day cumulative incidence of cytotoxic agent-induced DRP with/without ICIs was significantly higher in patients with ILA than in those without ILA (6.0 % vs. 1.2 %, p = 0.006). Multivariate analysis, adjusted for age, sex, and smoking history, revealed that ILA was associated with an increased risk of developing DRP due to cytotoxic agents with/without ICIs (hazard ratio [HR] 3.11, 95 % confidence interval [CI]: 1.06–9.14, p = 0.039) and cytotoxic agents alone (HR: 5.53, 95 % CI: 1.55–19.7, p = 0.008).

Conclusions

The presence of ILA is associated with an increased risk of developing DRP in patients undergoing cytotoxic agent-based chemotherapy. Therefore, evaluating the presence of ILA before determining chemotherapy regimens that include cytotoxic agents is recommended.

背景与目的：间质性肺异常（ILA）与多种疾病，包括药物相关性肺炎（DRP）之间的关系已被报道。然而，在接受基于细胞毒性药物的化疗（恶性肿瘤的标准治疗方法之一）的患者中，ILA的存在与发生DRP的关系尚不清楚。这需要紧急调查。方法：我们纳入了连续诊断为恶性肿瘤并接受细胞毒性药物治疗的患者（含/不含免疫检查点抑制剂（ICIs））。我们分别使用Gray's方法和多变量Fine-Gray亚分布风险分析来评估DRP的累积发生率（不良事件等级≥3的常用术语标准）和ILA与DRP发展之间的关系。结果：786例患者中，58例（7.3%）表现为ILA。ILA患者年龄较大，以男性为主，与没有ILA的患者相比，吸烟史较高。有/没有ICIs的ILA患者的90天累积细胞毒性药物诱导DRP发生率显著高于没有ICIs的患者（6.0% vs. 1.2%, p = 0.006）。经年龄、性别和吸烟史校正的多因素分析显示，ILA与细胞毒性药物合并/不合并ICIs（风险比[HR] 3.11, 95%可信区间[CI]: 1.06-9.14, p = 0.039）和单独使用细胞毒性药物（风险比[HR]: 5.53, 95% CI: 1.55-19.7, p = 0.008）导致DRP发生的风险增加相关。结论：ILA的存在与接受细胞毒性药物化疗的患者发生DRP的风险增加有关。因此，建议在确定包括细胞毒性药物的化疗方案之前评估ILA的存在。

{"title":"Association of interstitial lung abnormalities with cytotoxic agent-induced pneumonitis in patients with malignancy","authors":"Kyohei Oishi , Hironao Hozumi , Nobuko Yoshizawa , Shintaro Ichikawa , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Masato Karayama , Kazuki Furuhashi , Noriyuki Enomoto , Tomoyuki Fujisawa , Satoshi Goshima , Naoki Inui , Takafumi Suda","doi":"10.1016/j.rmed.2024.107924","DOIUrl":"10.1016/j.rmed.2024.107924","url":null,"abstract":"<div><h3>Background and objective</h3><div>The association between interstitial lung abnormalities (ILA) and various conditions and diseases, including drug-related pneumonitis (DRP), has been reported. However, the association of the presence of ILA with developing DRP in patients undergoing cytotoxic agent-based chemotherapy, one of the standard treatments for malignancies, remains unclear. This warrants urgent investigation.</div></div><div><h3>Methods</h3><div>We included consecutive patients diagnosed with malignancy and treated with cytotoxic agents with/without immune checkpoint inhibitors (ICIs). We used Gray's method and multivariate Fine-Gray sub-distribution hazards analysis to evaluate the cumulative incidence of DRP (common terminology criteria for adverse events grade of ≥3) and the association between ILA and DRP development, respectively.</div></div><div><h3>Results</h3><div>Among 786 patients, 58 (7.3 %) demonstrated ILA. Patients with ILA were older, predominantly male, and reported a higher smoking history compared to those without ILA. The 90-day cumulative incidence of cytotoxic agent-induced DRP with/without ICIs was significantly higher in patients with ILA than in those without ILA (6.0 % vs. 1.2 %, <em>p</em> = 0.006). Multivariate analysis, adjusted for age, sex, and smoking history, revealed that ILA was associated with an increased risk of developing DRP due to cytotoxic agents with/without ICIs (hazard ratio [HR] 3.11, 95 % confidence interval [CI]: 1.06–9.14, <em>p</em> = 0.039) and cytotoxic agents alone (HR: 5.53, 95 % CI: 1.55–19.7, <em>p</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>The presence of ILA is associated with an increased risk of developing DRP in patients undergoing cytotoxic agent-based chemotherapy. Therefore, evaluating the presence of ILA before determining chemotherapy regimens that include cytotoxic agents is recommended.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107924"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics of pulmonary rehabilitation programs and their effects on exercise capacity and health related quality of life (HRQoL) in patients with interstitial lung disease: A systematic review and meta-analysis 肺康复项目的特点及其对间质性肺病患者运动能力和健康相关生活质量（HRQoL）的影响：系统回顾与元分析》。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107936

Jaime Jiménez Salazar , Fatim Tahirah Mirza , Md Nazim Uzzaman , Ranita Hisham Shunmugam , Nik Zawani Shazana , Hilary Pinnock , Nikhil Hirani , Roberto A. Rabinovich

Background

Interstitial Lung Disease (ILD) is characterized by dyspnoea, reduced exercise capacity and poor health related quality of life (HRQoL). The evidence to support the benefits of pulmonary rehabilitation (PR) on exercise capacity (EC) and HRQoL in this population is still limited. We aimed to determine the effect of the different PR components on exercise capacity and HRQoL in patients with ILD.

Methods

We searched five databases (January 1990 to August 2024) using Population: ILD patients; Intervention: PR; Comparison: no PR; Outcomes: exercise capacity (e.g., 6-min walk test [6MWT] and HRQoL (e.g., St George's respiratory questionnaire [SGRQ]); Study type: randomised controlled trials (RCT). We used Cochrane risk-of-bias tool and GRADE to rate the quality of the evidence.

Findings

We identified 11 RCTs (476 ILD patients; 8 countries). 10 studies provided data for exercise capacity (6MWD) and 7 studies for HRQoL (SGRQ). Both 6MWD and SGRQ improved ≥ their respective mínimum clinically-important difference of 45m and 7 units respectively, in studies where PR programme was i) >8 weeks (n = 5) [6MWD: MD 58m, 95 % CI 37 to 79, p < 0.00001; SGRQ: MD -9.7, 95 % CI -12.6 to −6.7, p < 0.00001], ii) fully supervised [6MWD (n = 5): MD 53.6m, 95 % CI 39 to 68, p < 0.00001; SGRQ (n = 2): MD -9.38, 95 % CI -12.93 to −5.84, p < 0.00001] and iii) incorporated high-intensity interval training (HIIT) (n = 2) [6MWD: MD 77m, 95 % CI 45 to 109, p < 0.00001; SGRQ: MD -10.3, 95 % CI -13.7 to −6.9, p < 0.00001]

Interpretation

PR programs of >8 weeks, fully supervised and incorporated HIIT had a better clinical impact on EC and HRQoL.

背景：间质性肺疾病（ILD）以呼吸困难、运动能力下降和健康相关生活质量（HRQoL）差为特征。支持肺康复（PR）对该人群运动能力（EC）和HRQoL的益处的证据仍然有限。我们的目的是确定不同PR成分对ILD患者运动能力和HRQoL的影响。方法：我们检索了5个数据库（1990年1月至2024年8月），使用人群：ILD患者；干预:公关;对比：无PR；结果：运动能力（如6分钟步行测试[6MWT]）和HRQoL（如圣乔治呼吸问卷[SGRQ]）；研究类型：随机对照试验（RCT）。我们使用Cochrane风险偏倚工具和GRADE来评价证据的质量。结果：我们纳入了11项随机对照试验(476例ILD患者；8个国家)。10项研究提供了运动能力（6MWD）数据，7项研究提供了HRQoL （SGRQ）数据。在PR计划为1 ~ 8周（n=5）的研究中，6MWD和SGRQ分别改善≥各自的mínimum临床重要差异45m和7个单位[6MWD: MD 58m， 95% CI 37 ~ 79, p

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引用次数: 0

Mechanical power density, spontaneous breathing indexes, and weaning readiness following prolonged mechanical ventilation 机械功率密度、自主呼吸指数和长时间机械通气后的脱机准备情况。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2025.107943

Alessandro Ghiani , Swenja Walcher , Azal Lutfi , Lukas Gernhold , Sven Fabian Feige , Claus Neurohr

Introduction

Evidence suggests that mechanical power (MP) normalized to dynamic compliance, which equals power density, may help identify prolonged ventilated patients at risk for spontaneous breathing trial (SBT) failure. This study compared MP density with traditional spontaneous breathing indexes to predict a patient's capacity to sustain a short trial of unassisted breathing.

Methods

A prospective observational study on 186 prolonged ventilated, tracheotomized patients. We analyzed the first 30-min SBT upon weaning center admission, comparing MP density with spontaneous breathing indexes (e.g., predicted body weight normalized tidal volume (VT/PBW), rapid shallow breathing index (RSBI), and the integrative weaning index (IWI)) regarding SBT failure prediction, with diagnostic accuracy expressed as the area under the receiver operating characteristic curve (AUROC).

Results

SBT failure occurred in 51 out of 186 patients (27 %), who demonstrated significantly lower dynamic compliance (median 29 mL/cmH₂O [IQR 26–37] vs. 39 mL/cmH₂O [33–45]) and higher MP density (5837 cmH₂O²/min [4512–7758] vs. 2922 cmH₂O²/min [2001–4094]) before SBT, as well as lower spontaneous VT/PBW (5.7 mL∗kg⁻¹ [5.0–6.7] vs. 6.6 mL∗kg⁻¹ [5.9–7.8]), higher RSBI (73 min⁻¹∗L⁻¹ [57–100] vs. 59 min⁻¹∗L⁻¹ [45–76]), and lower IWI (40 L²/cmH₂O∗%∗min∗10⁻³ [27–50] vs. 63 L²/cmH₂O∗%∗min∗10⁻³ [46–91]) after 5 min of unassisted breathing. MP density was more accurate at predicting SBT failures (AUROC 0.86 [95%CI 0.80–0.91]) than VT/PBW (0.58 [0.50–0.65]), RSBI (0.54 [0.47–0.61]), or IWI (0.66 [0.58–0.73])).

Conclusions

MP density as a readiness criterion was more accurate at predicting weaning trial failures in prolonged ventilated, tracheotomized patients than traditional indexes assessed during unassisted breathing.

有证据表明，机械功率（MP）归一化为动态顺应性，等于功率密度，可能有助于识别有自发性呼吸试验（SBT）失败风险的长时间通气患者。本研究将MP密度与传统的自主呼吸指数进行比较，以预测患者维持短期无辅助呼吸试验的能力。方法：对186例长时间气管切开通气患者进行前瞻性观察研究。我们分析了进入脱机中心后的前30分钟SBT，将MP密度与自主呼吸指数（如预测体重归一化潮气量（VT/PBW））、快速浅呼吸指数（RSBI）和综合脱机指数（IWI）进行SBT失败预测的比较，诊断准确性表示为受试者工作特征曲线下面积（AUROC）。结果:186例患者中有51例（27%）出现SBT失败，SBT前患者动态依从性明显降低（中位数为29 mL/cmH2O [IQR 26-37] vs. 39 mL/cmH2O [33-45]）， MP密度较高（5837 cmH2O2/min [4512-7758] vs. 2922 cmH2O2/min[2001-4094]），自发性VT/PBW较低（5.7 mL*kg-1 [5.0-6.7] vs. 6.6 mL*kg-1 [5.9-7.8]）， RSBI较高（73 min-1*L-1 [57-100] vs. 59 min-1*L-1[45-76]）。无辅助呼吸5 min后IWI降低（L2/cmH2O*%*min*10-3为40 [27-50]，L2/cmH2O*%*min*10-3为63[46-91]）。MP密度预测SBT失效的准确度（AUROC 0.86 [95%CI 0.80-0.91]）高于VT/PBW（0.58[0.50-0.65]）、RSBI（0.54[0.47-0.61]）或IWI（0.66[0.58-0.73]）。结论：MP密度作为准备度标准，在预测长时间通气、气管切开患者的脱机试验失败时，比在无辅助呼吸时评估的传统指标更准确。

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引用次数: 0

The impact of blood eosinophil count and FeNO on benralizumab effectiveness in clinical practice: An ORBE II subanalysis 临床实践中，血嗜酸性粒细胞计数和FeNO对贝那利单抗有效性的影响：一项ORBE II亚分析。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2025.107940

Ismael García-Moguel , Álvaro Martínez-Mesa , Rubén Andújar-Espinosa , Rocío Díaz-Campos , José Luis Velasco-Garrido , Jose Luis Sanchez-Trincado , Elisa Luzon , Javier Nuevo , Carlos Alconada , Miguel Ángel Gutiérrez , Gabriel Niza , Alicia Padilla-Galo , ORBE II study group

Background

The ORBE II study showed the real-world effectiveness of benralizumab in severe eosinophilic asthma (SEA). This subgroup analysis aimed to characterize patients and outcomes based on baseline blood eosinophil count (BEC) and/or fractional exhaled nitric oxide (FeNO) levels.

Methods

In this analysis of the ORBE II retrospective study, SEA patients receiving benralizumab were categorized into subgroups based on individual or combined BEC/FeNO levels, according to the following thresholds: high BEC (hiBEC): ≥300 cells/μL; low BEC (loBEC): <300 cells/μL; high FeNO (hiFeNO): ≥50 ppb; low FeNO (loFeNO): <50 ppb. Baseline and up to 1 year of follow-up data are described.

Results

Most patients with available data were classified as hiBEC (72.6 %) and 38.3 % as hiFeNO. The distribution according to combined baseline BEC and FeNO levels revealed a heterogeneous patient population. Although common SEA features were shared among subgroups, some distinct characteristics were observed, including elevated allergic asthma prevalence in hiBEC/loFeNO patients, high obesity prevalence and fewer non-smokers in loBEC/loFeNO patients, remarkable severe exacerbation rates in loBEC/hiFeNO patients [5.5 SD (6.0)], and more severe symptoms in the hiBEC/loBEC subgroup. All subgroups showed benefits following benralizumab treatment, with super-responder rates ranging from 68.2 % to 83.3 % and clinical remission rates reaching 70.0 %. Particularly good responses were noted in hiBEC/hiFeNO patients.

Conclusions

This study shows the variability of T2 biomarkers in ORBE II SEA patients, emphasizing the prevalence of high BEC values. While benralizumab benefits were important regardless of BEC, high BEC predicted good outcomes and FeNO had less influence on treatment effectiveness.

背景：ORBE II研究显示了benralizumab治疗严重嗜酸性哮喘（SEA）的实际有效性。该亚组分析旨在根据基线血嗜酸性粒细胞计数（BEC）和/或呼出一氧化氮（FeNO）水平来描述患者和结果。方法：在ORBE II回顾性研究的分析中，接受benralizumab治疗的SEA患者根据单独或联合BEC/FeNO水平分为亚组，根据以下阈值：高BEC (hiBEC):≥300个细胞/μL；低BEC (loBEC)：结果：大多数可获得数据的患者被分类为hiBEC（72.6%）和hiFeNO（38.3%）。根据联合基线BEC和FeNO水平的分布揭示了患者群体的异质性。虽然SEA的共同特征在亚组中是相同的，但也观察到一些明显的特征，包括hiBEC/loFeNO患者过敏性哮喘患病率升高，loBEC/loFeNO患者高肥胖患病率和不吸烟者较少，loBEC/hiFeNO患者严重加重率显著[5.5 SD (6.0)]， hiBEC/loBEC亚组症状更严重。所有亚组在贝纳利珠单抗治疗后均显示获益，超应答率从68.2%到83.3%不等，临床缓解率达到70.0%。hiBEC/hiFeNO患者的反应特别好。结论：本研究显示了T2生物标志物在ORBE II SEA患者中的变异性，强调了高BEC值的普遍性。尽管无论BEC如何，benralizumab的益处都很重要，但高BEC预示着良好的结果，而FeNO对治疗效果的影响较小。

{"title":"The impact of blood eosinophil count and FeNO on benralizumab effectiveness in clinical practice: An ORBE II subanalysis","authors":"Ismael García-Moguel , Álvaro Martínez-Mesa , Rubén Andújar-Espinosa , Rocío Díaz-Campos , José Luis Velasco-Garrido , Jose Luis Sanchez-Trincado , Elisa Luzon , Javier Nuevo , Carlos Alconada , Miguel Ángel Gutiérrez , Gabriel Niza , Alicia Padilla-Galo , ORBE II study group","doi":"10.1016/j.rmed.2025.107940","DOIUrl":"10.1016/j.rmed.2025.107940","url":null,"abstract":"<div><h3>Background</h3><div>The ORBE II study showed the real-world effectiveness of benralizumab in severe eosinophilic asthma (SEA). This subgroup analysis aimed to characterize patients and outcomes based on baseline blood eosinophil count (BEC) and/or fractional exhaled nitric oxide (FeNO) levels.</div></div><div><h3>Methods</h3><div>In this analysis of the ORBE II retrospective study, SEA patients receiving benralizumab were categorized into subgroups based on individual or combined BEC/FeNO levels, according to the following thresholds: high BEC (hiBEC): ≥300 cells/μL; low BEC (loBEC): <300 cells/μL; high FeNO (hiFeNO): ≥50 ppb; low FeNO (loFeNO): <50 ppb. Baseline and up to 1 year of follow-up data are described.</div></div><div><h3>Results</h3><div>Most patients with available data were classified as hiBEC (72.6 %) and 38.3 % as hiFeNO. The distribution according to combined baseline BEC and FeNO levels revealed a heterogeneous patient population. Although common SEA features were shared among subgroups, some distinct characteristics were observed, including elevated allergic asthma prevalence in hiBEC/loFeNO patients, high obesity prevalence and fewer non-smokers in loBEC/loFeNO patients, remarkable severe exacerbation rates in loBEC/hiFeNO patients [5.5 SD (6.0)], and more severe symptoms in the hiBEC/loBEC subgroup. All subgroups showed benefits following benralizumab treatment, with super-responder rates ranging from 68.2 % to 83.3 % and clinical remission rates reaching 70.0 %. Particularly good responses were noted in hiBEC/hiFeNO patients.</div></div><div><h3>Conclusions</h3><div>This study shows the variability of T2 biomarkers in ORBE II SEA patients, emphasizing the prevalence of high BEC values. While benralizumab benefits were important regardless of BEC, high BEC predicted good outcomes and FeNO had less influence on treatment effectiveness.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107940"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107869

R. James White , Dario Vizza , Rogier Klok , Julia Harley , Mark Small , Dominik Lautsch

This study involved analyses of a real world, cross-sectional survey of physicians and their patients with pulmonary arterial hypertension (PAH). Physician and patient symptom concordance was assessed, and patients self-reported Health-Related Quality of Life (HRQoL). Data were drawn from the Adelphi PAH Disease Specific Programme (DSP)™ in the United States, France, Germany, Italy, Spain, United Kingdom, and Japan, between March and August 2022. EQ-5D 5L utility, EQ-5D Visual Analogue Scale (VAS) scores, and emPHasis-10 (e10) HRQoL scores were reported by patients. Physician-patient symptom concordance was analyzed with Cohen's Weighted Kappa (κ) analysis. Of 628 PAH patients, the mean (SD) EQ-5D VAS and e10 scores were 66 (17) and 23 (11). Data was stratified by World Health Organization Functional Class (WHO-FC). As WHO-FC increased, EQ-5D utility and VAS scores decreased and e10 scores increased, indicating poorer patient-reported HRQoL. Symptom concordance varied, ranging from κ = 0.11–0.57 (slight-moderate agreement), and physicians frequently underestimated the presence and severity of patient-reported symptoms. Future research should aim to bridge this gap between patient and physician understanding of HRQoL and the symptom burden associated with PAH.

本研究分析了一项针对医生及其肺动脉高压 (PAH) 患者的真实横断面调查。对医生和患者的症状一致性进行了评估，并由患者自我报告与健康相关的生活质量（HRQoL）。数据来自 2022 年 3 月至 8 月期间在美国、法国、德国、意大利、西班牙、英国和日本开展的 Adelphi PAH 疾病专项计划 (DSP)™。患者报告了 EQ-5D 5L 实用性、EQ-5D 视觉模拟量表 (VAS) 评分和 emPHasis-10 (e10) HRQoL 评分，并通过 Cohen's Weighted Kappa (κ)分析评估了医患症状一致性。在 628 名 PAH 患者中，EQ-5D VAS 和 e10 评分的平均值（标清）分别为 66（17）和 23（11）。数据按世界卫生组织功能分级（WHO-FC）进行分层。随着 WHO-FC 的增加，EQ-5D 实用性和 VAS 分数下降，e10 分数上升，表明患者报告的 HRQoL 较差。症状一致性不尽相同，从 κ = 0.11 到 0.57（轻度-中度一致性）不等，医生经常低估患者报告症状的存在和严重程度。未来的研究应致力于缩小患者和医生对 HRQoL 以及 PAH 相关症状负担的理解差距。

{"title":"Health-related quality of life and symptom concordance between patients and physicians in pulmonary arterial hypertension in the United States, Europe, and Japan","authors":"R. James White , Dario Vizza , Rogier Klok , Julia Harley , Mark Small , Dominik Lautsch","doi":"10.1016/j.rmed.2024.107869","DOIUrl":"10.1016/j.rmed.2024.107869","url":null,"abstract":"<div><div>This study involved analyses of a real world, cross-sectional survey of physicians and their patients with pulmonary arterial hypertension (PAH). Physician and patient symptom concordance was assessed, and patients self-reported Health-Related Quality of Life (HRQoL). Data were drawn from the Adelphi PAH Disease Specific Programme (DSP)™ in the United States, France, Germany, Italy, Spain, United Kingdom, and Japan, between March and August 2022. EQ-5D 5L utility, EQ-5D Visual Analogue Scale (VAS) scores, and emPHasis-10 (e10) HRQoL scores were reported by patients. Physician-patient symptom concordance was analyzed with Cohen's Weighted Kappa (κ) analysis. Of 628 PAH patients, the mean (SD) EQ-5D VAS and e10 scores were 66 (17) and 23 (11). Data was stratified by World Health Organization Functional Class (WHO-FC). As WHO-FC increased, EQ-5D utility and VAS scores decreased and e10 scores increased, indicating poorer patient-reported HRQoL. Symptom concordance varied, ranging from κ = 0.11–0.57 (slight-moderate agreement), and physicians frequently underestimated the presence and severity of patient-reported symptoms. Future research should aim to bridge this gap between patient and physician understanding of HRQoL and the symptom burden associated with PAH.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107869"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The psychological disorder and personality traits of individuals with pulmonary nodules 肺结节患者的心理障碍与人格特征。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.rmed.2024.107938

Xianping Guo , Xiaoli Zhu

Introduction

With the widespread use of Low-dose computed tomography (LDCT) in the chest, more and more people will be detected with pulmonary nodules. The presence of uncertainty following the detection of these nodules can impose significant psychological distress. This study aimed to investigate personality traits, psychological distress, and their impact on pulmonary nodule patients in China.

Methods

We conducted a cross-sectional survey of adults with pulmonary nodules accidently discovered by LDCT in the chest from the respiratory outpatient department.

Results

A total of 224 patients with pulmonary nodules were included in this study.

The prevalence of anxiety among patients with pulmonary nodules was found to be 47.8 %, while the prevalence of depression was reported to be 44.2 %. The present study also demonstrated a higher prevalence of anxiety among female patients with pulmonary nodules compared to their male counterparts, with mild anxiety being the predominant manifestation. The multivariate logistic regression analysis revealed that age (OR = 0.926, P < 0.01), gender (OR = 3.24, P < 0.01), number of pulmonary nodules (OR = 0.586, P < 0.05), lung cancer-related characteristics (OR = 5.423, P < 0.01), PTSD (OR = 5.715, P < 0.01), and Extroversion personality traits (OR = 1.087, P < 0.05) were significant factors contributing to anxiety in patients with pulmonary nodules. Similarly, (OR = 0.891, P < 0.01), gender (OR = 2.981, P < 0.05), duration (OR = 0.663, P < 0.05), lung cancer-related characteristics (OR = 5.707, P < 0.01), PTSD (OR = 4.420, P < 0.01)emerged as key factors associated with depression in this patient population.

Conclusion

Approximately 50 % of patients with pulmonary nodules exhibit negative affective states. Furthermore, as time progresses, the negative emotional burden of anxiety and depression in individuals with pulmonary nodules tends to alleviate.

随着低剂量计算机断层扫描（LDCT）在胸部的广泛应用，越来越多的人被发现有肺结节。这些结节检测后的不确定性会造成严重的心理困扰。本研究旨在探讨人格特质、心理困扰及其对中国肺结节患者的影响。方法：我们对呼吸道门诊经LDCT在胸部意外发现肺结节的成年人进行了横断面调查。结果：本研究共纳入224例肺结节患者。肺结节患者焦虑患病率为47.8%，抑郁患病率为44.2%。本研究还表明，与男性患者相比，女性肺结节患者的焦虑患病率更高，以轻度焦虑为主要表现。多因素logistic回归分析显示，年龄（OR=0.926, p）对肺结节患者的影响显著。此外，随着时间的推移，肺结节患者焦虑和抑郁的负性情绪负担趋于减轻。

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引用次数: 0