Reliability of crackles in fibrotic interstitial lung disease: a prospective, longitudinal study.

IF 5.8 2区 医学 Q1 Medicine
Giacomo Sgalla, Jacopo Simonetti, Arianna Di Bartolomeo, Tonia Magrì, Bruno Iovene, Giuliana Pasciuto, Ruben Dell'Ariccia, Francesco Varone, Alessia Comes, Paolo Maria Leone, Venere Piluso, Alessandro Perrotta, Giuseppe Cicchetti, Diana Verdirosi, Luca Richeldi
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Abstract

Background: Although crackles on chest auscultation represent a fundamental component of the diagnostic suspect for fibrotic interstitial lung disease (ILD), their reliability has not been properly studied. We assessed the agreement among respiratory physicians on the presence and changes over time of audible crackles collected in a prospective longitudinal cohort of patients with fibrotic ILD.

Methods: Lung sounds were digitally recorded at baseline and after 12 months at eight anatomical sites. Nine respiratory physicians blindly assessed randomized couples of recordings obtained from the same anatomical site at different timepoints. The physicians indicated the presence of crackles in individual recordings and which recording from each couple eventually had more intense crackles. Fleiss' kappa coefficient was used to measure inter- and intra-rater agreement.

Results: Fifty-two patients, mostly with a diagnosis of IPF (n = 40, 76.9%) were prospectively enrolled between October 2019 and May 2021. The final acoustic dataset included 702 single recordings, corresponding to 351 couples of recordings from baseline and 12-months timepoints. Kappa coefficient was 0.57 (95% CI 0.55-0.58) for the presence of crackles and 0.42 (95% CI 0.41-0.43) for acoustic change. Intra-rater agreement, measured for three respiratory physicians on three repeated assessments, ranged from good to excellent for the presence of crackles (κ = 0.87, κ = 0.86, κ = 0.79), and from moderate to good for acoustic change (κ = 0.75, κ = 0.76, κ = 0.57).

Conclusions: Agreement between respiratory physicians for the presence of crackles and acoustic change was acceptable, suggesting that crackles represent a reliable acoustic finding in patients with fibrotic ILD. Their role as a lung-derived indicator of disease progression merits further studies.

纤维化间质性肺病噼啪声的可靠性:一项前瞻性纵向研究。
背景:尽管胸部听诊噼啪声是纤维化间质性肺病(ILD)疑似诊断的基本组成部分,但其可靠性尚未得到适当研究。我们评估了呼吸科医生对纤维化间质性肺病患者前瞻性纵向队列中收集到的可闻噼啪声的存在和随时间变化的一致性:方法:分别在基线和 12 个月后对 8 个解剖部位的肺音进行数字记录。九名呼吸科医生对不同时间点同一解剖部位的随机记录进行盲法评估。医生们指出单个记录中是否存在噼啪声,以及每对记录中哪个记录最终出现了更强烈的噼啪声。弗莱斯卡帕系数用于衡量评分者之间和评分者内部的一致性:在 2019 年 10 月至 2021 年 5 月期间,52 名患者进行了前瞻性登记,其中大部分被诊断为 IPF(n = 40,76.9%)。最终的声学数据集包括 702 个单次记录,对应于基线和 12 个月时间点的 351 对记录。对于是否存在噼啪声,Kappa系数为0.57(95% CI 0.55-0.58);对于声学变化,Kappa系数为0.42(95% CI 0.41-0.43)。三名呼吸科医生在三次重复评估中的评分者内部一致性从良好到优秀(κ = 0.87、κ = 0.86、κ = 0.79),声学变化从中等到良好(κ = 0.75、κ = 0.76、κ = 0.57):结论:呼吸科医生对是否存在噼啪声和声学变化的一致意见是可以接受的,这表明噼啪声是纤维化 ILD 患者可靠的声学发现。作为疾病进展的肺源性指标,噼啪声的作用值得进一步研究。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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