BMC Pulmonary Medicine最新文献

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive pulmonary disorder with persistent respiratory symptoms resulting from abnormalities in the airways and/or alveoli and was prevalent globally in 10.3% of people aged 30-79 years in 2019. The prevalence of COPD has increased rapidly in women in the past decade. This may be due to increased tobacco use, but may also involve sex-specific factors.

Purpose: To evaluate the prevalence of COPD in the context of sex and tobacco exposure.

Data sources and searches: Comprehensive searches of MEDLINE (OVID), EMBASE and CENTRAL were conducted for articles published from inception to July 22, 2022.

Study selection: We independently evaluated titles, abstracts and full-text articles in a duplicated two-staged process. Studies were included if they reported the prevalence of COPD as a primary outcome in the context of sex and tobacco exposure.

Data synthesis and analysis: Pooled analysis was conducted with Review Manager 5, and heterogeneity was assessed with the I² statistic. For 163, 450 individuals the prevalence of COPD was 3.5-20.7% in males and 6.3-18.5% in females, and we observed a non-statistically significant difference of 1.53% [95% CI: -5.83, 8.89] (p = 0.68) in females compared to males with tobacco exposure (Tau² = 54.02; Chi² = 53.15; df = 4 (P < 0.00001); I² = 92%). Females with COPD had earlier mortality, greater co-morbidities involving cardiovascular disease and others, and decreased FEV₁% predicted, as compared to males with COPD. Estrogen and androgens may protect against COPD, but smoking-induced hypogonadism may diminish these effects. Menopause could also be a contributor to worse COPD outcomes.

Limitations: Included articles are limited by the quality of data on tobacco smoke exposure, primarily reported as a binary risk factor, with lack of availability on duration and intensity of exposure.

Conclusion: There was earlier mortality and reduced FEV₁ in females with COPD, as compared to males with COPD. Thus, sex-specific considerations are important in understanding the pathophysiology of COPD and should be a focus of further research.

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.

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.

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.