BMC Pulmonary Medicine最新文献

Background: For patients with chronic thromboembolic pulmonary hypertension (CTEPH), balloon pulmonary angioplasty (BPA) has been associated with superior reductions in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) when compared to riociguat. In patients with pulmonary arterial hypertension (PAH), greater clinical improvements were observed after switching from phosphodiesterase-5 inhibitors (PDE5i) to riociguat. However, the impact of transitioning from PDE5i to riociguat on pulmonary haemodynamics and functional outcomes after BPA remains unclear.

Methods: This prospective, open-label, single-arm, study enrolled CTEPH patients who remained symptomatic following BPA. After a 24-hour PDE5i washout period, patients were switched to riociguat. At week 26, primary outcomes assessed changes in haemodynamics including PVR and mPAP. Secondary endpoints evaluated cardiac index; functional status including WHO functional class, 6-minute walking distance (6MWD), REVEAL Lite 2 score; biochemical markers such as N-terminal prohormone of brain natriuretic peptide (NT-proBNP); and echocardiographic measurements of right-heart function. Treatment-related adverse events and clinical worsening were monitored throughout the study.

Results: From July 2024 to January 2025, 16 patients (mean age 62.3 ± 14.6 years; 75% female) were recruited, with 14 completing the 26-week follow-up. At week 26, significant reductions occurred in PVR (-2.16 Wood units; CI -3.64 to -0.69; p = 0.007) and mPAP (-4.79 mmHg; Confidence Interval [CI] -8.05 to -1.52; p = 0.007). Significant improvements were also noted in cardiac index, WHO functional class, 6MWD, REVEAL Lite 2 score and NT-proBNP levels. Echocardiographic measurements of right-heart function did not demonstrate significant improvement. Treatment-related adverse events were observed in 11 patients (68.75%). Clinical worsening occurred in four patients, including two deaths unrelated to treatment and two unplanned hospitalisations due to pulmonary hypertension.

Conclusion: In CTEPH patients after completion of BPA, replacing PDE5i with riociguat significantly enhanced pulmonary haemodynamics and functional capacity but was accompanied by a considerable risk of treatment-related adverse events.

Trial registration: ClinicalTrials.gov Identifier NCT06715280 retrospectively registered on 26/11/2024.

Background: Cystic fibrosis (CF) is a multi-organ disorder in which respiratory complications account for the majority of its cause of mortality. This study aimed to investigate the factors associated with pulmonary hypertension (PH) in pediatric patients with CF and acute pulmonary exacerbations (PEx).

Methods: This is a prospective cross-sectional study that enrolled children with CF who were hospitalized with PEx in a university hospital between 2020 and 2022. All patients underwent echocardiography, and their pulmonary artery pressure (PAP) was measured. They were then divided into two groups based on the presence or absence of PH. Clinical symptoms, spirometry, six-minute walk tests, laboratory findings, chest radiography, and other clinical parameters were compared in these two groups. The restricted cubic spline was plotted for variables with nonlinear associations with PH.

Result: A total of 107 pediatric patients were included in this study. The prevalence of PH in the studied population was 24.3%. Group 1 consisted of 81 patients with normal PAP values (PAP < 25 mmHg), and group 2 included 26 patients with increased levels of PAP (PAP ≥ 25 mmHg). Group 2 had significantly higher median age, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels, as well as a greater frequency of major chest X-ray abnormalities and NIV use compared to group 1. Univariate logistic regression demonstrated that older age (OR 1.191, 95% CI 1.052-1.348, p = 0.006), elevated CRP (OR 1.027, 95% CI 1.009-1.046, p = 0.004), ESR ≥ 21 mm/hr (OR: 3.567, 95% CI: 1.350-9.427, p = 0.010), lower lymphocyte counts (OR 0.972, 95% CI 0.946-0.999, p = 0.044), and NIV requirement (OR 3.055, 95% CI 1.230-7.586, p = 0.016) were significantly associated with an increased likelihood of PH. In multivariate analyses adjusted for confounders, older age (OR 1.176, 95% CI 1.035-1.337, p = 0.013), elevated CRP (OR 1.024, 95% CI 1.004-1.044, p = 0.020), ESR ≥ 21 mm/hr (OR: 1.149, 95% CI: 1.008-1.310, p = 0.037), and NIV requirement (OR 2.860, 95% CI 1.102-7.422, p = 0.031) remained independently associated with having PH.

Conclusion: In patients with CF and PEx, factors that suggest the possibility of concurrent PH include older age, infiltration or bronchiectasis on chest X-ray, NIV requirements, and elevated inflammatory markers.

Objective: This study aimed to identify short-term mortality risk factors for patients with acute respiratory failure (ARF) the MIMIC-IV database, construct a prognostic nomogram and evaluate its predictive performance compared to conventional scoring systems.

Methods: Clinical data from patients diagnosed with ARF were retrospectively collected from the MIMIC-IV database and randomly divided into training and validation groups. The variables were selected via the Lasson regression, and a nomogram was constructed. The nomogram was compared with acute physiology score III (APSIII), simplified acute physiology scores II (SAPS II) and oxford acute severity of illness score (OASIS) model via the C-index, area under the receiver operating characteristic curve (ROC), net reclassification index (NRI), integrated discrimination improvement index (IDI), decision curve analysis (DCA).

Results: A total of 559 patients were included. The study identified nine independent risk factors: age (HR: 1.022, 95% CI: 1.008-1.036, P = 0.002), WBC (HR: 1.060, 95% CI:1.033-1.086, P < 0.001), glucose levels (HR:1.002, 95% CI: 1.001-1.004, P = 0.003), temperature (HR: 0.544, 95% CI: 0.430-0.689, P < 0.001), metastatic solid tumor (HR: 2.138, 95% CI: 1.045-4.372, P = 0.037), malignant cancer (HR: 2.455, 95% CI: 1.456-4.138, P < 0.001), diabetes without chronic complications (HR: 0.288, 95% CI: 0.157-0.807, P < 0.001), cerebrovascular disease (HR: 2.156, 95% CI: 1.180-3.940, P = 0.012), dementia (HR: 2.23, 95% CI: 1.132-4.392, P = 0.020). The nomogram demonstrated strong discriminative performance with C-indices of 0.782 and 0.749 in the training and validation sets, respectively. The AUC for the Training and Validation cohorts were 0.811 (APS III: 0.652; SAPS II: 0.672; OASIS: 0.624) and 0.790 (APS III: 0.634; SAPS II: 0.652; OASIS: 0.609), respectively. The nomogram also significantly outperformed traditional scoring systems, as evidenced by positive NRI and IDI values.

Conclusion: The newly developed nomogram exhibits superior predictive capability to traditional scoring systems (APS III, SAPS II and OASIS scores), offering clinicians a practical and reliable tool for accurately assessing short-term mortality risks in ICU patients with ARF.

Background: Current understanding indicates that primary spontaneous pneumothorax (PSP) typically occurs in younger individuals, whereas secondary spontaneous pneumothorax (SSP) is more common in older patients. However, the specific age distribution patterns distinguishing these two types of spontaneous pneumothorax (SP) remain poorly characterized. Furthermore, while a low partial pressure of oxygen (PaO₂) is a recognized clinical feature of pneumothorax, limited research has explored whether lower PaO₂ levels are specifically indicative of underlying lung disease in patients with SSP.

Methods: In this observational cohort study, we enrolled 473 male SP patients over a six-year period. We use frequency distribution plots to observe the distribution differences of continuous variables between SSP and PSP patients. Receiver operating characteristic (ROC) curve analysis and logistic regression modeling were employed to quantify the association between age, PaO₂, and SSP.

Results: The frequency distributions of age and PaO₂ were bimodal in patients with PSP and SSP. Multivariate logistic regression analysis identified age (using a cutoff of > 50 vs. ≤50 years) and PaO₂ (using a cutoff of > 90 vs. ≤90 mmHg) as independent factors associated with SSP, with odds ratios (ORs) of 10.58 (95% CI: 6.15-18.20) and 0.45 (95% CI: 0.27-0.74), respectively. While alternative cutoffs of age (> 40 vs. ≤40 years) and PaO₂ (> 85 vs. ≤85 mmHg) were also significant, with ORs of 7.74 (95% CI: 4.46-13.41) and 0.32 (95% CI: 0.19-0.55), the OR for age was lower (a decrease of 2.84 from the > 50-year cutoff). ROC curve analysis showed that the sensitivity and specificity for distinguishing SSP were 0.835 (95%CI: 0.812-0.853) and 0.789 (95%CI: 0.779-0.801), respectively, for the 50-year age cutoff, and 0.746 (95% CI: 0.721-0.762) and 0.679 (95%CI: 0.652-0.698) for the 90 mmHg PaO₂ cutoff.

Conclusion: Among male patients with SP, an age of 50 years offers higher sensitivity and specificity than an age of 40 years in distinguishing SSP from PSP. Furthermore, even after oxygen administration, PaO₂ levels in SSP patients remain lower than those in PSP patients. A PaO₂ threshold of 90 mmHg also demonstrates high sensitivity and specificity in differentiating SSP from PSP.

Objective: To develop and validate a prediction model for metastasis risk in lung cancer patients based on circulating biomarkers and clinical factors, thereby facilitating early risk assessment.

Methods: A total of 511 lung cancer patients who received treatment in the hospital from January 2020 to December 2024 were selected. Their clinical data and laboratory test indicators were collected and divided into a training set (n = 358) and a validation set (n = 153) at a ratio of 7:3. In the training set, risk factors were screened by univariate and multivariate Logistic regression to construct a nomogram model. The receiver operating characteristic curve (ROC) and calibration curve were drawn to evaluate the model's efficacy, and the model was validated in the validation set. Decision curve analysis (DCA) was used to evaluate the clinical value.

Results: In the training set, 143 cases (39.94%) had lung cancer metastasis, and in the validation set, 61 cases (39.87%) had lung cancer metastasis. Multivariate Logistic regression showed that lymph node status, Total Prostate-Specific Antigen (TPSA), Carcinoembryonic Antigen (CEA), tumor size, Carbohydrate Antigen 19 - 9(CA199) and Alpha-Fetoprotein were significantly associated with the risk of lung cancer metastasis (all P < 0.05). The nomogram demonstrated consistent performance across the training and validation sets, with C-indices of 0.714 and 0.710, and AUCs of 0.714 (95% CI: 0.649-0.778), with a sensitivity of 0.571 and a specificity of 0.745 and 0.710 (95% CI: 0.609-0.812), with a sensitivity of 0.622 and a specificity of 0.629, respectively. The P values of the Hosmer - Lemeshow test were 0.183 and 0.075, indicating a good model fit, respectively.

Conclusion: The nomogram model constructed based on circulating biomarkers and clinical factors can effectively predict the metastasis risk of lung cancer patients and has certain clinical application value. However, multi - center and large - sample studies are still needed for further validation.