Idiopathic pulmonary arterial hypertension (IPAH) is a progressive and fatal disease characterized by pathological pulmonary vascular remodeling and right heart failure. Current biomarkers for IPAH demonstrate limited clinical utility, necessitating the discovery of noninvasive serum biomarkers to facilitate early diagnosis and prognosis.
Objective
To identify novel serum biomarkers for IPAH using tandem mass tag–based quantitative proteomics and validate their clinical relevance.
Methods
Serum samples from five IPAH patients and five age/sex-matched healthy controls (discovery cohort) were analyzed by tandem mass tag proteomics to screen differentially expressed proteins (DEPs). Functional enrichment and protein–protein interaction network analyses were performed. Serum galectin-3 binding protein (LGALS3BP) levels were validated by enzyme-linked immunosorbent assay (ELISA) in an expanded cohort (30 IPAH patients vs. 30 controls).
Results
Proteomic analysis identified 401 proteins and 1554 peptide fragments, with 114 DEPs between groups (47 up-regulated and 67 down-regulated). In biological processes, DEPs are primarily enriched in adaptive immune response, followed by signal transduction. Extracellular exosome and extracellular region are the most commonly enriched cell components. For molecular function, DEPs are mainly involved in antigen binding and calcium ion binding, with the top 30 Gene Ontology terms exhibiting similar distribution patterns between up- and down-regulated DEPs. Pathway analysis revealed significant enrichment in complement/coagulation cascades, immune response, and extracellular matrix remodeling. LGALS3BP was observed to be significantly up-regulated in IPAH serum compared with controls (fold change = 1.36, p < 0.001), a finding validated by independent ELISA (IPAH: 6.43 ± 1.73 μg/mL vs. controls: 2.33 ± 1.06 μg/mL; p < 0.001).
Conclusions
Integrated proteomic profiling and clinical validation provide the first evidence of elevated serum LGALS3BP in IPAH, indicating its putative role in pathogenesis and translational medicine.
特发性肺动脉高压（IPAH）是一种以病理性肺血管重构和右心衰为特征的进行性致命疾病。目前IPAH的生物标志物临床应用有限，需要发现无创血清生物标志物以促进早期诊断和预后。目的利用串联质量标记定量蛋白质组学技术鉴定IPAH的新型血清生物标志物，并验证其临床意义。方法采用串联质量标签蛋白质组学方法对5例IPAH患者和5例年龄/性别匹配的健康对照组（发现队列）的血清样本进行分析，筛选差异表达蛋白（DEPs）。功能富集和蛋白相互作用网络分析。在扩大的队列（30例IPAH患者和30例对照组）中，通过酶联免疫吸附试验（ELISA）验证血清半乳糖凝集素-3结合蛋白（LGALS3BP）水平。结果通过蛋白质组学分析，共鉴定出401个蛋白和1554个肽段，组间共鉴定出114个dep，其中上调47个，下调67个。在生物过程中，DEPs主要富集于适应性免疫反应，其次是信号转导。胞外外泌体和胞外区是最常见的富集细胞成分。在分子功能上，DEPs主要参与抗原结合和钙离子结合，前30个基因本体术语在上调和下调DEPs之间表现出相似的分布模式。通路分析显示补体/凝血级联、免疫反应和细胞外基质重塑显著富集。与对照组相比，IPAH血清中LGALS3BP明显上调（倍增变化= 1.36,p < 0.001），独立ELISA验证了这一发现（IPAH: 6.43±1.73 μg/mL，对照组：2.33±1.06 μg/mL, p < 0.001）。综合蛋白质组学分析和临床验证提供了IPAH患者血清LGALS3BP升高的第一个证据，表明其在发病机制和转化医学中的推测作用。
{"title":"Serum Proteomic Profiling Uncovers LGALS3BP as a Potential Biomarker for Idiopathic Pulmonary Arterial Hypertension","authors":"Mingfei Li, Qi Jin, Wenzhi Pan, Dan Tian, Peng Wang, Dandan Chen, Yuan Zhang, Shasha Chen, Daxin Zhou, Lihua Guan, Junbo Ge","doi":"10.1111/crj.70138","DOIUrl":"https://doi.org/10.1111/crj.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Idiopathic pulmonary arterial hypertension (IPAH) is a progressive and fatal disease characterized by pathological pulmonary vascular remodeling and right heart failure. Current biomarkers for IPAH demonstrate limited clinical utility, necessitating the discovery of noninvasive serum biomarkers to facilitate early diagnosis and prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify novel serum biomarkers for IPAH using tandem mass tag–based quantitative proteomics and validate their clinical relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Serum samples from five IPAH patients and five age/sex-matched healthy controls (discovery cohort) were analyzed by tandem mass tag proteomics to screen differentially expressed proteins (DEPs). Functional enrichment and protein–protein interaction network analyses were performed. Serum galectin-3 binding protein (LGALS3BP) levels were validated by enzyme-linked immunosorbent assay (ELISA) in an expanded cohort (30 IPAH patients vs. 30 controls).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Proteomic analysis identified 401 proteins and 1554 peptide fragments, with 114 DEPs between groups (47 up-regulated and 67 down-regulated). In biological processes, DEPs are primarily enriched in adaptive immune response, followed by signal transduction. Extracellular exosome and extracellular region are the most commonly enriched cell components. For molecular function, DEPs are mainly involved in antigen binding and calcium ion binding, with the top 30 Gene Ontology terms exhibiting similar distribution patterns between up- and down-regulated DEPs. Pathway analysis revealed significant enrichment in complement/coagulation cascades, immune response, and extracellular matrix remodeling. LGALS3BP was observed to be significantly up-regulated in IPAH serum compared with controls (fold change = 1.36, <i>p</i> < 0.001), a finding validated by independent ELISA (IPAH: 6.43 ± 1.73 μg/mL vs. controls: 2.33 ± 1.06 μg/mL; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrated proteomic profiling and clinical validation provide the first evidence of elevated serum LGALS3BP in IPAH, indicating its putative role in pathogenesis and translational medicine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID-19 pandemic due to SARS-CoV-2 has initiated historically unparalleled global health, social, and economic impacts. Syntheses of the multivariable interdependent effects on the multiple clinical, immunologic, psychosocial, and health service realms are required to guide current and future public health preparedness and policy.
Methods
A systematic review of a meta-analysis was conducted using the PubMed, Scopus, and Web of Science databases from December 2019 to 2025 to identify observational studies and randomized controlled trials. Quantitative reporting studies of COVID-19 outcomes were included. Random-effects model aggregated effect sizes were estimated and tested for heterogeneity with Cochran's Q, τ2, and I2. Subgroup, moderator, publication bias, sensitivity, and leave-one-out analyses were conducted for exploration and validation.
Results
Twenty-four studies were classified into three categories: clinical outcomes (15 studies), immunogenicity (4 studies), and psychosocial/health service outcomes (5 studies). There was no statistically significant pooled effect (effect ratio 0.95, 95% CI: 0.55–1.62) with severe heterogeneity (I2 > 99%). Immunogenicity showed a statistically significant positive effect (pooled estimate 0.77, 95% CI: 0.38–1.16) with high heterogeneity (I2 ~96%). Psychosocial effects were highly heterogeneous with non-significant overall effects (estimate −1.03, 95% CI: −5.74 to 3.69). Sample size was an influential moderator that explained significant between-group heterogeneity.
Discussion
The outcomes reveal robust immunogenic vaccine impacts and indeterminate psychosocial and clinical impacts, consistent with the heterogeneity and complexity of COVID-19 effects. Great heterogeneity highlights methodological standardization and cautious interpretation. This present meta-analysis offers key lessons to guide subsequent study design and manufacture of fair health policy and pandemic readiness.
{"title":"COVID-19 Pandemic: A Comprehensive Meta-Review of Global Impacts, Responses, and Future Preparedness","authors":"Rulin Wang, Muhammad Ahsan Naeem","doi":"10.1111/crj.70134","DOIUrl":"10.1111/crj.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The COVID-19 pandemic due to SARS-CoV-2 has initiated historically unparalleled global health, social, and economic impacts. Syntheses of the multivariable interdependent effects on the multiple clinical, immunologic, psychosocial, and health service realms are required to guide current and future public health preparedness and policy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of a meta-analysis was conducted using the PubMed, Scopus, and Web of Science databases from December 2019 to 2025 to identify observational studies and randomized controlled trials. Quantitative reporting studies of COVID-19 outcomes were included. Random-effects model aggregated effect sizes were estimated and tested for heterogeneity with Cochran's Q, <i>τ</i><sup>2</sup>, and <i>I</i><sup>2</sup>. Subgroup, moderator, publication bias, sensitivity, and leave-one-out analyses were conducted for exploration and validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four studies were classified into three categories: clinical outcomes (15 studies), immunogenicity (4 studies), and psychosocial/health service outcomes (5 studies). There was no statistically significant pooled effect (effect ratio 0.95, 95% CI: 0.55–1.62) with severe heterogeneity (<i>I</i><sup>2</sup> > 99%). Immunogenicity showed a statistically significant positive effect (pooled estimate 0.77, 95% CI: 0.38–1.16) with high heterogeneity (I<sup>2</sup> ~96%). Psychosocial effects were highly heterogeneous with non-significant overall effects (estimate −1.03, 95% CI: −5.74 to 3.69). Sample size was an influential moderator that explained significant between-group heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The outcomes reveal robust immunogenic vaccine impacts and indeterminate psychosocial and clinical impacts, consistent with the heterogeneity and complexity of COVID-19 effects. Great heterogeneity highlights methodological standardization and cautious interpretation. This present meta-analysis offers key lessons to guide subsequent study design and manufacture of fair health policy and pandemic readiness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Follicular dendritic cell sarcoma (FDCS) is an uncommon malignant neoplasm that arises from follicular dendritic cells (FDCs). The mediastinum is a more unusual site of FDCS. In this document, we detail a case involving the complete surgical removal of FDCS located in the mediastinum. A 28-year-old woman presented with symptoms of right chest pain. Accompanying symptoms include chest tightness, shortness of breath, and faintness. Chest computed tomography was performed and revealed abnormal enhancement in the mediastinal region. An excisional biopsy was carried out, and through the aid of immunohistochemistry (IHC), a diagnosis of FDCS was confirmed. Following surgery, the patient underwent radiotherapy for 27 sessions. The patient was followed up by the oncology service for 6 years and was still alive at the time of drafting this report. This exceedingly uncommon case underscores the challenges in making a differential diagnosis and emphasizes the significance of diagnostic indicators, including histopathology and IHC, in establishing a diagnosis. Clinicians should be alert to the possibility of encountering this disease and take into consideration various characteristics to avoid misdiagnosis.
{"title":"Follicular Dendritic Cell Sarcoma in Mediastinum: A Case Study and Literature Review","authors":"Qingxia Xu, Chong Zhang, Yang Ma, Longquan Xiang","doi":"10.1111/crj.70140","DOIUrl":"10.1111/crj.70140","url":null,"abstract":"<p>Follicular dendritic cell sarcoma (FDCS) is an uncommon malignant neoplasm that arises from follicular dendritic cells (FDCs). The mediastinum is a more unusual site of FDCS. In this document, we detail a case involving the complete surgical removal of FDCS located in the mediastinum. A 28-year-old woman presented with symptoms of right chest pain. Accompanying symptoms include chest tightness, shortness of breath, and faintness. Chest computed tomography was performed and revealed abnormal enhancement in the mediastinal region. An excisional biopsy was carried out, and through the aid of immunohistochemistry (IHC), a diagnosis of FDCS was confirmed. Following surgery, the patient underwent radiotherapy for 27 sessions. The patient was followed up by the oncology service for 6 years and was still alive at the time of drafting this report. This exceedingly uncommon case underscores the challenges in making a differential diagnosis and emphasizes the significance of diagnostic indicators, including histopathology and IHC, in establishing a diagnosis. Clinicians should be alert to the possibility of encountering this disease and take into consideration various characteristics to avoid misdiagnosis.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Respiratory mechanics and gas exchange parameters are readily accessible indicators for evaluating ventilation in patients with acute respiratory distress syndrome (ARDS). Computed tomography (CT) is a widely used radiological imaging technique, while electrical impedance tomography (EIT) is a novel technique for pulmonary function monitoring developed in recent years. Studies suggest that EIT combined with quantitative CT holds unique value in assessing ventilation/perfusion (V/Q) function. Unlike classic ARDS, the pathophysiologic alterations in ARDS following lung transplantation are complex, and the specific mechanisms remain unclear. This study aims to explore the use of respiratory mechanics, gas exchange parameters, EIT, and quantitative CT for the multimodal assessment of V/Q function in post-lung transplantation ARDS. We further aim to integrate visualizing dynamic imaging and regional quantitative lung analysis into this multimodal assessment system.</p> </section> <section> <h3> Method</h3> <p>We retrospectively enrolled lung transplant recipients admitted to the intensive care unit who met the Berlin criteria for ARDS. Inclusion required an arterial partial pressure of oxygen to fraction of inspired oxygen ratio (P/F) ≤ 300 mmHg, with both EIT monitoring of V/Q and high-resolution CT performed within 24 h of documented P/F ≤ 300 mmHg. Patient baseline characteristics, respiratory mechanics parameters, gas exchange parameters, EIT data, and CT images were collected. Subjects were stratified into two groups according to P/F values: a low P/F group (P/F < 200 mmHg) and a high P/F group (200 mmHg ≤ P/F ≤ 300 mmHg). Ventilation parameters derived from EIT included global inhomogeneity index (GI), center of ventilation (COV), and regional ventilation delay index (RVDI). Using hypertonic saline contrast-enhanced EIT, we acquired V/Q parameters and calculated both global and regional EIT-based dead space fraction (EIT-Dead Space), intrapulmonary shunt fraction (EIT-Shunt), and V/Q matching (EIT-V/Q Match). Chest CT images were processed through a multitask learning U-net-based computer-aided diagnostic model. This enabled semiautomated lung segmentation, identification of high-density lesions, quantitative analysis, and three-dimensional visualization. Pulmonary volumes, lesion volumes, and percentage lesion volumes (calculated as lung lesion volume divided by lung volume) were, respectively, quantified for the left and right lungs.</p> </section> <section> <h3> Result</h3> <p>The study ultimately enrolled 21 lung transplant recipients with ARDS, comprising five patients in the low P/F group and 16 in
{"title":"EIT Outperforms Quantitative CT in Stratifying ARDS Severity After Lung Transplantation: A Retrospective Study","authors":"Hui Jiang, Hu Zhao, Wei Cui, Xinxin Zhu, Ruoruo Yang, Yuqiang Wang, Xia Zheng","doi":"10.1111/crj.70135","DOIUrl":"10.1111/crj.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory mechanics and gas exchange parameters are readily accessible indicators for evaluating ventilation in patients with acute respiratory distress syndrome (ARDS). Computed tomography (CT) is a widely used radiological imaging technique, while electrical impedance tomography (EIT) is a novel technique for pulmonary function monitoring developed in recent years. Studies suggest that EIT combined with quantitative CT holds unique value in assessing ventilation/perfusion (V/Q) function. Unlike classic ARDS, the pathophysiologic alterations in ARDS following lung transplantation are complex, and the specific mechanisms remain unclear. This study aims to explore the use of respiratory mechanics, gas exchange parameters, EIT, and quantitative CT for the multimodal assessment of V/Q function in post-lung transplantation ARDS. We further aim to integrate visualizing dynamic imaging and regional quantitative lung analysis into this multimodal assessment system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We retrospectively enrolled lung transplant recipients admitted to the intensive care unit who met the Berlin criteria for ARDS. Inclusion required an arterial partial pressure of oxygen to fraction of inspired oxygen ratio (P/F) ≤ 300 mmHg, with both EIT monitoring of V/Q and high-resolution CT performed within 24 h of documented P/F ≤ 300 mmHg. Patient baseline characteristics, respiratory mechanics parameters, gas exchange parameters, EIT data, and CT images were collected. Subjects were stratified into two groups according to P/F values: a low P/F group (P/F < 200 mmHg) and a high P/F group (200 mmHg ≤ P/F ≤ 300 mmHg). Ventilation parameters derived from EIT included global inhomogeneity index (GI), center of ventilation (COV), and regional ventilation delay index (RVDI). Using hypertonic saline contrast-enhanced EIT, we acquired V/Q parameters and calculated both global and regional EIT-based dead space fraction (EIT-Dead Space), intrapulmonary shunt fraction (EIT-Shunt), and V/Q matching (EIT-V/Q Match). Chest CT images were processed through a multitask learning U-net-based computer-aided diagnostic model. This enabled semiautomated lung segmentation, identification of high-density lesions, quantitative analysis, and three-dimensional visualization. Pulmonary volumes, lesion volumes, and percentage lesion volumes (calculated as lung lesion volume divided by lung volume) were, respectively, quantified for the left and right lungs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>The study ultimately enrolled 21 lung transplant recipients with ARDS, comprising five patients in the low P/F group and 16 in ","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jian Yu, Chi Peng, Qianwen Ye, Cong Huo, Binrui Gao, Qing Wei, Yibo Li, Kaidi Yang
Background
Malignant pleural mesothelioma (MPM) is an insidious and aggressive tumor, often hindering timely clinical interventions. Despite its clinical relevance, epidemiological research focusing on MPM metastases remains limited.
Methods
We conducted a retrospective review of MPM cases with site-specific metastasis records from the Surveillance, Epidemiology, and End Results (SEER) between 2010 and 2019. Propensity Score Matching was employed to minimize bias between distant metastasis and non-distant metastasis groups. A prognostic model for predicting overall survival was established using clinical variables derived from Lasso regression. Variable importance for survival outcomes was estimated using the Random Survival Forests algorithm. The performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curves and calibration plots.
Results
The presence of distant metastasis significantly reduced median overall survival from 10.5 to 7 months, with further detriment observed in cases with sarcomatoid histology and without chemotherapy intervention. Multivariable analysis identified sarcomatoid subtype, T4 stage, N1+ nodal involvement, and bilateral disease as significant predictors of increased metastatic potential. Histology, surgery, and metastasis status emerged as the top three clinical variables influencing survival. The nomogram demonstrated strong discrimination and calibration for predicting the 1-year and 3-year overall survival in both training and validation cohorts. The contralateral lung was the most frequent site of distant metastasis, with lymph node metastasis presenting a significantly better prognosis than that observed in patients with metastases to other organs.
Conclusions
The large population-based analysis provides a comprehensive characterization of site-specific metastases in MPM. The identified risk factors can help stratify patients at higher risk for metastatic progression and support early, targeted clinical decision-making.
{"title":"Distant Metastatic Pattern and Its Prognostic Significance in Malignant Pleural Mesothelioma: A Population-Based Study Based on a Machine Learning Model","authors":"Jian Yu, Chi Peng, Qianwen Ye, Cong Huo, Binrui Gao, Qing Wei, Yibo Li, Kaidi Yang","doi":"10.1111/crj.70133","DOIUrl":"10.1111/crj.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malignant pleural mesothelioma (MPM) is an insidious and aggressive tumor, often hindering timely clinical interventions. Despite its clinical relevance, epidemiological research focusing on MPM metastases remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective review of MPM cases with site-specific metastasis records from the Surveillance, Epidemiology, and End Results (SEER) between 2010 and 2019. Propensity Score Matching was employed to minimize bias between distant metastasis and non-distant metastasis groups. A prognostic model for predicting overall survival was established using clinical variables derived from Lasso regression. Variable importance for survival outcomes was estimated using the Random Survival Forests algorithm. The performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curves and calibration plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The presence of distant metastasis significantly reduced median overall survival from 10.5 to 7 months, with further detriment observed in cases with sarcomatoid histology and without chemotherapy intervention. Multivariable analysis identified sarcomatoid subtype, T4 stage, N1+ nodal involvement, and bilateral disease as significant predictors of increased metastatic potential. Histology, surgery, and metastasis status emerged as the top three clinical variables influencing survival. The nomogram demonstrated strong discrimination and calibration for predicting the 1-year and 3-year overall survival in both training and validation cohorts. The contralateral lung was the most frequent site of distant metastasis, with lymph node metastasis presenting a significantly better prognosis than that observed in patients with metastases to other organs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The large population-based analysis provides a comprehensive characterization of site-specific metastases in MPM. The identified risk factors can help stratify patients at higher risk for metastatic progression and support early, targeted clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ozkan Saydam, Celal Bugra Sezen, Melike Ülker, Umut Kilimci, Oguzhan Bayraktar, Mustafa Vedat Doğru, Cemal Aker, Muzaffer Metin
Purpose
Our aim in this study is to evaluate the safety and efficacy of surgery in patients undergoing chest wall resection due to non-small cell lung cancer (NSCLC) based on age groups.
Methods
The study was conducted retrospectively on 160 patients with NSCLC who underwent chest wall resection between 2009 and 2019. Patients were classified into Group A (under 70 years) and Group B (70 years and older).
Results
The study found a complication rate of 28.1%, but no negative impact of the geriatric age group on complications was determined. The risk of complications varied depending on the number of ribs removed (p = 0.035). The survival rate for Group A was 72%, while for Group B it was 93% (p = 0.189). No significant differences were found in terms of gender, Charlson Comorbidity Index (CCI), and histopathological results. In patients who underwent lobectomy, survival was 85%, while a significant difference was observed in those who underwent pneumonectomy, with a survival rate of 41% (p < 0.001).
Conclusion
It was determined that advanced age is not a prognostic factor in surgical resection regarding complications and survival, with the most important prognostic factors being the type of resection and the stage of the disease.
{"title":"Is Chest Wall Resection Safe in Geriatric Non-Small Cell Lung Cancer?","authors":"Ozkan Saydam, Celal Bugra Sezen, Melike Ülker, Umut Kilimci, Oguzhan Bayraktar, Mustafa Vedat Doğru, Cemal Aker, Muzaffer Metin","doi":"10.1111/crj.70137","DOIUrl":"10.1111/crj.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Our aim in this study is to evaluate the safety and efficacy of surgery in patients undergoing chest wall resection due to non-small cell lung cancer (NSCLC) based on age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was conducted retrospectively on 160 patients with NSCLC who underwent chest wall resection between 2009 and 2019. Patients were classified into Group A (under 70 years) and Group B (70 years and older).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study found a complication rate of 28.1%, but no negative impact of the geriatric age group on complications was determined. The risk of complications varied depending on the number of ribs removed (<i>p</i> = 0.035). The survival rate for Group A was 72%, while for Group B it was 93% (<i>p</i> = 0.189). No significant differences were found in terms of gender, Charlson Comorbidity Index (CCI), and histopathological results. In patients who underwent lobectomy, survival was 85%, while a significant difference was observed in those who underwent pneumonectomy, with a survival rate of 41% (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was determined that advanced age is not a prognostic factor in surgical resection regarding complications and survival, with the most important prognostic factors being the type of resection and the stage of the disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To construct and validate a nomogram model for predicting the risk of ICU ventilator weaning failure (reintubation or death within 48 h after extubation) based on multidimensional clinical indicators.
Methods
A total of 485 patients in the ICU who needed ventilator weaning were selected and divided into a training set (n = 340) and a validation set (n = 145) at a ratio of 7:3. Baseline data and weaning-related indicators of the patients were collected. Weaning failure (reintubation or death within 48 h after weaning) was regarded as the outcome event. Independent risk factors were screened through univariate and multivariate logistic regression. A nomogram model was constructed, and the model's performance was evaluated using the C-index, AUC, calibration curve, Hosmer–Lemeshow test, and decision curve.
Results
The weaning failure rate in the training set was 28.53% (97/340), and that in the validation set was 29.66% (43/145). Multivariate regression showed that age, APACHE II score, duration of mechanical ventilation, spontaneous breathing frequency, Glasgow Coma Scale score, and the use of sedatives were independent influencing factors (p < 0.05). The C-index of the nomogram model in the training set and the validation set was 0.829 and 0.826, respectively. The AUC was 0.828 (95% CI: 0.762–0.893) and 0.823 (95% CI: 0.732–0.915), respectively. The sensitivity and specificity were 0.811, 0.751 and 0.662, 0.702, respectively. The calibration curve and Hosmer–Lemeshow test (p = 0.109, 0.402) showed that the model had a good fit.
Conclusion
The nomogram model constructed based on the above indicators can effectively predict the risk of ICU ventilator weaning failure and provide a basis for formulating individualized weaning strategies.
{"title":"Real-Time Predictive Analysis of ICU Ventilator Weaning Failure: A Prospective Validation Study","authors":"Lili Zhou, Peng Zhou, Changling Gao, Taozi Li, Qiaoyun Zhou","doi":"10.1111/crj.70136","DOIUrl":"https://doi.org/10.1111/crj.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To construct and validate a nomogram model for predicting the risk of ICU ventilator weaning failure (reintubation or death within 48 h after extubation) based on multidimensional clinical indicators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 485 patients in the ICU who needed ventilator weaning were selected and divided into a training set (<i>n</i> = 340) and a validation set (<i>n</i> = 145) at a ratio of 7:3. Baseline data and weaning-related indicators of the patients were collected. Weaning failure (reintubation or death within 48 h after weaning) was regarded as the outcome event. Independent risk factors were screened through univariate and multivariate logistic regression. A nomogram model was constructed, and the model's performance was evaluated using the C-index, AUC, calibration curve, Hosmer–Lemeshow test, and decision curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The weaning failure rate in the training set was 28.53% (97/340), and that in the validation set was 29.66% (43/145). Multivariate regression showed that age, APACHE II score, duration of mechanical ventilation, spontaneous breathing frequency, Glasgow Coma Scale score, and the use of sedatives were independent influencing factors (<i>p</i> < 0.05). The C-index of the nomogram model in the training set and the validation set was 0.829 and 0.826, respectively. The AUC was 0.828 (95% CI: 0.762–0.893) and 0.823 (95% CI: 0.732–0.915), respectively. The sensitivity and specificity were 0.811, 0.751 and 0.662, 0.702, respectively. The calibration curve and Hosmer–Lemeshow test (<i>p</i> = 0.109, 0.402) showed that the model had a good fit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The nomogram model constructed based on the above indicators can effectively predict the risk of ICU ventilator weaning failure and provide a basis for formulating individualized weaning strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lung cancer is one of the common cancers globally. One of the adverse symptoms of lung cancer and its treatment is fatigue. Pharmacological interventions have not shown efficacy on cancer-related fatigue, and investigations on nonpharmacological interventions may be useful. This systematic review aims to evaluate the efficacy of nonpharmacological interventions on managing fatigue and quality of life outcomes among people undergoing treatment for lung cancer and evaluate if treatment efficacy differed between single and multimodal interventions.
Methods
Relevant literature published in MEDLINE, Scopus, Cochrane Library, CINAHL, and ProQuest from January 2003 to January 2023 was included. Included studies must have: participants over 16 years of age receiving treatment such as chemotherapy, radiotherapy, and/or surgery, cancer-related fatigue (CRF) as an outcome, and must be randomized controlled trials. Two reviewers independently extracted data from eligible articles, and data analysis was performed using R 4.1.0 software.
Results
Total of 14 randomized controlled trials were included and categorized into four groups: physical activities, traditional Chinese medicine (TCM), education, and dietary counselling. Our extensive search did not find any multimodal studies related to CRF in patients with lung cancer. Pooled results of this systematic review found that TCM and education interventions have a significant positive impact on fatigue in patients with lung cancer. Physical activity and dietary counselling were not effective in managing fatigue. None of the reported nonpharmacological interventions in this review significantly impact QoL.
Conclusions
This review identified that TCM and educational programs improved CRF in patients with lung cancer. However, physical activities and dietary counselling did not show any improvements in fatigue for patients undergoing lung cancer treatment.
{"title":"Comparison of Single Versus Multiple Nonpharmacological Interventions for the Management of Lung Cancer–Related Fatigue: A Systematic Review","authors":"Audrey A. Almassi, Clarice Y. Tang, Sheree Smith","doi":"10.1111/crj.70132","DOIUrl":"10.1111/crj.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung cancer is one of the common cancers globally. One of the adverse symptoms of lung cancer and its treatment is fatigue. Pharmacological interventions have not shown efficacy on cancer-related fatigue, and investigations on nonpharmacological interventions may be useful. This systematic review aims to evaluate the efficacy of nonpharmacological interventions on managing fatigue and quality of life outcomes among people undergoing treatment for lung cancer and evaluate if treatment efficacy differed between single and multimodal interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Relevant literature published in MEDLINE, Scopus, Cochrane Library, CINAHL, and ProQuest from January 2003 to January 2023 was included. Included studies must have: participants over 16 years of age receiving treatment such as chemotherapy, radiotherapy, and/or surgery, cancer-related fatigue (CRF) as an outcome, and must be randomized controlled trials. Two reviewers independently extracted data from eligible articles, and data analysis was performed using R 4.1.0 software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total of 14 randomized controlled trials were included and categorized into four groups: physical activities, traditional Chinese medicine (TCM), education, and dietary counselling. Our extensive search did not find any multimodal studies related to CRF in patients with lung cancer. Pooled results of this systematic review found that TCM and education interventions have a significant positive impact on fatigue in patients with lung cancer. Physical activity and dietary counselling were not effective in managing fatigue. None of the reported nonpharmacological interventions in this review significantly impact QoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review identified that TCM and educational programs improved CRF in patients with lung cancer. However, physical activities and dietary counselling did not show any improvements in fatigue for patients undergoing lung cancer treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Registration</h3>\u0000 \u0000 <p>PROSPERO registration ID: CRD42023407326.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jian Fan, Haoran Ni, Xiulan Chen, Yulin Duan, Wanmin Wang, Fan Xu, Yan Shang
<div> <section> <h3> Background</h3> <p>In the field of respiratory system diseases, the utilization of respiratory sounds in auscultation plays a crucial role in the specific disease diagnosis. However, during the process of auscultation, the personal experiences and environmental factors may affect the decision making, leading to diagnostic errors. Therefore, to accurately and effectively obtain and analyze respiratory sounds can be positively contribute to the diagnosis and treatment of respiratory system diseases.</p> </section> <section> <h3> Objectives</h3> <p>Our aim was to develop an analytical method for the visualization and digitization of respiratory audio data, and to validate its capability to differentiate between various background diseases.</p> </section> <section> <h3> Methods</h3> <p>This study collected the respiratory sounds of patients admitted to the Department of General Medicine of Shanghai Changhai Hospital from June to December 2023. After strict screening according to the inclusion and exclusion criteria, a total of 84 patients were included. The research process includes using an electronic stethoscope to collect lung sounds from patients in a quiet environment. The patients expose their chests and lie flat. Sound data are collected at six landmark positions on the chest. The collected audio files are imported into an analysis tool for segmentation and feature extraction. Specific analysis methods include distinguishing heart sounds and respiratory sounds, segmenting respiratory sounds, determining the inspiratory and expiratory phases, and using a tool developed by the team for automatic segmentation encoding.</p> </section> <section> <h3> Results</h3> <p>We standardized the respiratory sounds of 84 patients and segmented multiple respiratory cycles. Following the localization and segmentation of the respiratory cycles based on label information, we calculated the average and standard deviation of the amplitude features for each segment of the respiratory cycle. The results indicated differences among various diseases.</p> </section> <section> <h3> Conclusions</h3> <p>The robust algorithm platform is capable of segmenting the respiratory sounds into inhale and exhale phases accordingly, then comparing the difference between different background diseases. This method provides objective evidence for the auscultation of respiratory sounds and visual display of breath sounds.</p> </section> </div
{"title":"Construction and Validation of an Automatic Segmentation Method for Respiratory Sound Time Labels","authors":"Jian Fan, Haoran Ni, Xiulan Chen, Yulin Duan, Wanmin Wang, Fan Xu, Yan Shang","doi":"10.1111/crj.70124","DOIUrl":"10.1111/crj.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the field of respiratory system diseases, the utilization of respiratory sounds in auscultation plays a crucial role in the specific disease diagnosis. However, during the process of auscultation, the personal experiences and environmental factors may affect the decision making, leading to diagnostic errors. Therefore, to accurately and effectively obtain and analyze respiratory sounds can be positively contribute to the diagnosis and treatment of respiratory system diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Our aim was to develop an analytical method for the visualization and digitization of respiratory audio data, and to validate its capability to differentiate between various background diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study collected the respiratory sounds of patients admitted to the Department of General Medicine of Shanghai Changhai Hospital from June to December 2023. After strict screening according to the inclusion and exclusion criteria, a total of 84 patients were included. The research process includes using an electronic stethoscope to collect lung sounds from patients in a quiet environment. The patients expose their chests and lie flat. Sound data are collected at six landmark positions on the chest. The collected audio files are imported into an analysis tool for segmentation and feature extraction. Specific analysis methods include distinguishing heart sounds and respiratory sounds, segmenting respiratory sounds, determining the inspiratory and expiratory phases, and using a tool developed by the team for automatic segmentation encoding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We standardized the respiratory sounds of 84 patients and segmented multiple respiratory cycles. Following the localization and segmentation of the respiratory cycles based on label information, we calculated the average and standard deviation of the amplitude features for each segment of the respiratory cycle. The results indicated differences among various diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The robust algorithm platform is capable of segmenting the respiratory sounds into inhale and exhale phases accordingly, then comparing the difference between different background diseases. This method provides objective evidence for the auscultation of respiratory sounds and visual display of breath sounds.</p>\u0000 </section>\u0000 </div","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).
Methods
We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.
Results
The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO2/FiO2 (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25–13.26; p = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).
Conclusion
In this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60-day mortality, it was linked to prolonged RICU hospitalization.
目的：本回顾性研究旨在探讨呼吸道重症监护病房（RICU）危重患者艰难梭菌感染（CDI）的危险因素及临床结局。方法：我们招募了在RICU住院期间出现腹泻并进行艰难梭菌毒素检测的成年患者。根据检测结果将患者分为CDI组和艰难梭菌阴性腹泻（CDN）组。比较两组CDI的危险因素和临床结果。结果：RICU患者CDI发生率为8.3%。与CDN组相比，CDI组PaO2/FiO2 （P/F）比值显著降低（中位数135比189 mmHg， P = 0.012），肠外营养（83.78%比60.0%,P = 0.012）、血管加压药（62.16%比40.0%,P = 0.029）和镇痛药（72.97%比47.14%,P = 0.01）的使用比例较高。多因素分析显示，男性是CDI的危险因素（OR, 4.07; 95% CI, 1.25-13.26; p = 0.02）。CDI组60天死亡率无显著性增高（35.14% vs. 34.29%; p = 0.976）。CDI患者的幸存者表现出更好的氧合（175.43比102.88 mmHg, p = 0.004）和更低的SOFA评分（6.38比9.0,p = 0.017）。未发现死亡的独立危险因素。CDI患者的RICU停留时间显著延长（中位数：32天vs. 21.5天，p = 0.02）。结论：在本研究中，男性与CDI风险增加独立相关。虽然CDI对60天死亡率没有显著影响，但它与RICU住院时间延长有关。
{"title":"Risk Factors and Outcomes of Clostridioides difficile Infection in Respiratory Intensive Care Unit Patients","authors":"Tingting Hou, Yifang Huang, Jinjun Jiang, Yuanlin Song, Shujing Chen","doi":"10.1111/crj.70130","DOIUrl":"10.1111/crj.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This retrospective study aimed to investigate the risk factors and clinical outcomes of <i>Clostridioides difficile</i> infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent <i>C. difficile</i> toxin testing. Patients were stratified into two groups based on test results: CDI group and <i>Clostridioides difficile</i>-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO<sub>2</sub>/FiO<sub>2</sub> (P/F) ratios (median 135 vs. 189 mmHg, <i>p</i> = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, <i>p</i> = 0.012), vasopressor use (62.16% vs. 40.0%, <i>p</i> = 0.029), and analgesic administration (72.97% vs. 47.14%, <i>p</i> = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25–13.26; <i>p</i> = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; <i>p</i> = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; <i>p</i> = 0.004) and lower SOFA scores (6.38 vs. 9.0; <i>p</i> = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60-day mortality, it was linked to prolonged RICU hospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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