European Respiratory Review最新文献

{"title":"Artificial intelligence in bronchoscopy: a systematic review.","authors":"Kristoffer Mazanti Cold, Anishan Vamadevan, Christian B Laursen, Flemming Bjerrum, Suveer Singh, Lars Konge","doi":"10.1183/16000617.0274-2024","DOIUrl":"https://doi.org/10.1183/16000617.0274-2024","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) systems have been implemented to improve the diagnostic yield and operators' skills within endoscopy. Similar AI systems are now emerging in bronchoscopy. Our objective was to identify and describe AI systems in bronchoscopy.</p><p><strong>Methods: </strong>A systematic review was performed using MEDLINE, Embase and Scopus databases, focusing on two terms: bronchoscopy and AI. All studies had to evaluate their AI against human ratings. The methodological quality of each study was assessed using the Medical Education Research Study Quality Instrument (MERSQI).</p><p><strong>Results: </strong>1196 studies were identified, with 20 passing the eligibility criteria. The studies could be divided into three categories: nine studies in airway anatomy and navigation, seven studies in computer-aided detection and classification of nodules in endobronchial ultrasound, and four studies in rapid on-site evaluation. 16 were assessment studies, with 12 showing equal performance and four showing superior performance of AI compared with human ratings. Four studies within airway anatomy implemented their AI, all favouring AI guidance to no AI guidance. The methodological quality of the studies was moderate (mean MERSQI 12.9 points, out of a maximum 18 points).</p><p><strong>Interpretation: </strong>20 studies developed AI systems, with only four examining the implementation of their AI. The four studies were all within airway navigation and favoured AI to no AI in a simulated setting. Future implementation studies are warranted to test for the clinical effect of AI systems within bronchoscopy.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the minimum important differences for field walking tests in adults with long-term conditions: a systematic review and meta-analysis.","authors":"Enya Daynes, Ruth E Barker, Amy V Jones, Jessica A Walsh, Claire M Nolan, William D-C Man, Sally J Singh, Neil J Greening, Linzy Houchen-Wolloff, Rachael A Evans","doi":"10.1183/16000617.0198-2024","DOIUrl":"https://doi.org/10.1183/16000617.0198-2024","url":null,"abstract":"<p><strong>Importance: </strong>The minimum important difference (MID) for field walking tests aims to improve interpretation of outcomes, but the volume and heterogeneity of MIDs for these tests is challenging. We aimed to determine the MID for the 6-min walk distance (6MWD), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with long-term conditions.</p><p><strong>Methods: </strong>This systematic review included studies that generated a MID using an anchor-based approach in patients with long-term conditions for the 6MWD, ISWT or ESWT field walking tests. Studies were screened and data extracted by independent reviewers. Meta-analyses were performed using RevMan.</p><p><strong>Results: </strong>42 studies were included in the analyses, involving n=13 949 participants. Of these, 12 studies involving exercise as an intervention were included in the meta-analyses to produce MIDs, presented as mean (95% confidence interval). The MID for the 6MWD was 25 m (24-26 m) for respiratory conditions, 23 m (8-37 m) for cardiac conditions and 37 m (26-49 m) for neurological/musculoskeletal conditions. The MID for the ISWT was 48 m (39-57 m) for respiratory conditions and 70 m (55-85 m) for cardiac conditions. The MID for ESWT in COPD was 159 s (94-224 s). The pooled MID across conditions within exercise interventions was 26 m (22-40 m) for the 6MWD and 53 m (44-62 m) for the ISWT, with reasonable heterogeneity (I²=48% and I²=47%, respectively).</p><p><strong>Conclusion: </strong>We propose new MIDs for exercise interventions using anchor-based methodology in long‑term conditions for the 6MWD, ISWT and ESWT. These can be used internationally for meta‑analyses where studies have used different field walking tests, to optimise trial sample size calculations, and for clinical service benchmarking.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Live teleultrasound for evaluation of the chest: a systematic review.","authors":"Victor Duong, Liam M Hannan, Kirstin Tirant, Yee Xian Choe, Erica Hateley, Sanjeevan Muruganandan","doi":"10.1183/16000617.0260-2024","DOIUrl":"https://doi.org/10.1183/16000617.0260-2024","url":null,"abstract":"<p><strong>Background: </strong>Innovation in ultrasound technology has led to the development of portable devices which can transmit images in real time to a remotely located expert, known as live teleultrasound. This allows immediate feedback on image acquisition, assistance with interpretation and subsequent clinical decision-making.</p><p><strong>Aim: </strong>We performed a systematic review of the literature to examine outcomes related to live teleultrasound of the chest.</p><p><strong>Methods: </strong>A systematic search for studies reporting outcomes from live teleultrasound of the chest (excluding cardiac) in adults was performed in PubMed, MEDLINE, Embase, CINAHL and Cochrane CENTRAL. At least two independent reviewers were involved in screening, data extraction and critical appraisal.</p><p><strong>Results: </strong>In total, 1855 eligible studies were identified. Of those, 106 studies progressed to full-text screening and 43 studies were included for data extraction. Case reports and feasibility studies were most prevalent, and study quality was low overall. Commonly reported outcomes included 1) image quality rated by a remote clinician; 2) remote clinician's comfort in making management decisions; and 3) comparison of teleultrasound image acquisition with images acquired at the bedside by an expert. Three diagnostic accuracy studies demonstrated a high accuracy of teleultrasound for the identification of signs such as lung sliding, the interstitial syndrome and pleural effusion. Consolidation was less reliably identified. Eight studies collected qualitative data on attitudes of remote and face-to-face clinicians, which were consistently positive.</p><p><strong>Conclusion: </strong>Low-quality evidence suggests that live teleultrasound can be used to assess the lungs and pleural space; however, further study is required to ensure its diagnostic accuracy.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung volumes, gas transfer and oscillometry after preterm birth: systematic review and meta-analysis.","authors":"James T D Gibbons, Michael L Beaven, Christopher W Course, Sarah J Kotecha, Thomas Hixson, Melissa Zuidersma, Andrew C Wilson, Sailesh Kotecha, Shannon J Simpson","doi":"10.1183/16000617.0151-2024","DOIUrl":"https://doi.org/10.1183/16000617.0151-2024","url":null,"abstract":"<p><strong>Background: </strong>Small airway and lung parenchymal abnormalities frequently occur following preterm birth but are commonly missed by spirometry. Static lung volumes, diffusing capacity of the lung for carbon monoxide (<i>D</i> _LCO) and oscillometry provide a more precise characterisation of these conditions. We hypothesised that differences in these measures exist between individuals born preterm and at term and we aimed to systematically review the literature to identify and quantify these differences in lung function.</p><p><strong>Methods: </strong>This systematic review and meta-analysis, registered with PROSPERO (CRD42022320775) and guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, searched six databases up to 29 December 2024. We included studies comparing lung function between preterm subjects and term controls <i>via</i> static lung volumes, gas transfer or oscillometry. Differences in lung function were analysed using random-effects meta-analysis to compute the standardised mean difference (SMD).</p><p><strong>Results: </strong>From 12 143 titles, we analysed 52 cohorts with static lung volumes, 37 with gas transfer and 18 with oscillometry data. While total lung capacity was similar between preterm and term cohorts (SMD -0.08, 95% CI -0.17 to 0.004), preterm participants showed increased residual volume (SMD 0.32, 95% CI 0.19 to 0.44) and residual volume/total lung capacity (SMD 0.45, 95% CI 0.28 to 0.63). <i>D</i> _LCO was lower in preterm cohorts (SMD -0.51, 95% CI -0.64 to -0.38). Preterm cohorts also demonstrated increased airway resistance at 5/6 Hz (SMD 0.44, 95% CI 0.22 to 0.67), difference between airway resistance at 5/6 Hz and 20 Hz (SMD 0.51, 95% CI 0.07 to 0.96), resonant frequency (SMD 0.63, 95% CI 0.12 to 1.15) and area under the reactance curve (SMD 0.62, 95% CI 0.35 to 0.88).</p><p><strong>Interpretation: </strong>We demonstrate that preterm birth is linked to notable abnormalities in static lung volumes, gas transfer and oscillometry, underscoring the necessity of employing comprehensive pulmonary function tests beyond spirometry to monitor and address long-term respiratory outcomes effectively.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"20 years of the Montreal Cystic Fibrosis Related Diabetes Screening Cohort: key insights.","authors":"Laure Alexandre-Heymann, Valérie Boudreau, Dylan Lim, Danna Cepeda, Heather Girouard, Annick Lavoie, François Tremblay, Rémi Rabasa-Lhoret, Adèle Coriati","doi":"10.1183/16000617.0220-2024","DOIUrl":"https://doi.org/10.1183/16000617.0220-2024","url":null,"abstract":"<p><strong>Introduction: </strong>The Montreal Cystic Fibrosis Related Diabetes Screening Cohort (MCFC) was established in 2004 to study the prevalence, risk factors and management of cystic fibrosis-related diabetes, a significant extrapulmonary complication of cystic fibrosis with an increasing prevalence due to improved cystic fibrosis survival rates. The aims of this review are to highlight the key insights gained from monitoring the MCFC over 20 years, and to discuss the challenges and advantages of establishing such a cohort in a rare disease like cystic fibrosis.</p><p><strong>Methods: </strong>Adult people with cystic fibrosis were recruited from 2004 onward in Montreal, Canada, excluding those already diagnosed with cystic fibrosis-related diabetes. Clinical and biological results (including oral glucose tolerance tests) were recorded regularly.</p><p><strong>Results: </strong>Findings from the MCFC contributed to a better understanding of cystic fibrosis-related diabetes pathophysiology (in particular, the joint roles of reduced insulin secretion and added insulin resistance) and its relationship with lung function. Over the years, we observed a shift towards overweight and obesity among cystic fibrosis patients, along with improved lung function. This could be due to improved cystic fibrosis care and to the introduction of cystic fibrosis transmembrane conductance regulator modulators. We were also able to validate new, simplified screening modalities and management strategies (<i>e.g.</i> physical activity) for cystic fibrosis-related diabetes.</p><p><strong>Conclusion: </strong>The MCFC has contributed to the understanding of cystic fibrosis-related diabetes and informed best practice guidelines. Future research will focus on how cystic fibrosis transmembrane conductance regulator modulators influence glycaemic control and cardiometabolic health in people with cystic fibrosis.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of patient-reported outcome measures in pulmonary arterial hypertension clinical trials: a systematic review, meta-analysis and health-related quality of life framework.","authors":"Frances Varian, Rebecca Burney, Charlotte Pearson, Ze Ming Goh, Joseph Newman, Gregg Rawlings, Hamza Zafar, David G Kiely, A A Roger Thompson, Robin Condliffe, Mark Toshner, Ciara McCormack, Iain Armstrong, Tessa Peasgood, Jill Carlton, Alexander M K Rothman","doi":"10.1183/16000617.0006-2025","DOIUrl":"https://doi.org/10.1183/16000617.0006-2025","url":null,"abstract":"<p><strong>Introduction: </strong>Health-related quality of life (HRQoL) in pulmonary arterial hypertension (PAH) is valued as an outcome measure by patients, clinicians and regulators. The selection of patient-reported outcome measures (PROMs) for measurement of HRQoL in PAH clinical trials lacks systematic evaluation of their suitability, accuracy and reliability.</p><p><strong>Methods: </strong>We report a systematic review (PROSPERO ID: CRD42024484021) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of PROMs selected in PAH clinical trials. PROM measurement properties were then evaluated according to the 10-step COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and graded by recommendation for use. Finally, HRQoL was modelled into a conceptual framework using patient interviews and surveys.</p><p><strong>Results: </strong>Screening of 896 records identified 90 randomised controlled trials. 43 trials selected PROMs, of which 20 were sufficiently validated to detect meaningful change. Of these, eight trials were adequately powered, using either EuroQol-five dimensions-five levels (EQ-5D-5L), Short-Form-36 (SF-36) or the Living with Pulmonary Hypertension Questionnaire (LPHQ). The COSMIN evaluation recommended EmPHasis-10 and the LPHQ for use (grade A); whereas, SF-36 and EQ-5D-5L require further study (grade B). A conceptual framework of HRQoL was developed from literature comprising 8045 patients. This framework can be used to visualise the different HRQoL concepts measured by different PROMs.</p><p><strong>Conclusion: </strong>To improve patient-centred research, greater consistency in PROM selection is required. Three of 90 randomised controlled trials have selected COSMIN-recommended PROMs. Whilst the PROMs evaluated require development across the 10 areas of psychometric property measurement, EmPHasis-10 and the LPHQ can be recommended for use. The ratified conceptual framework can further support PROM selection by identifying the HRQoL concepts they are likely to capture.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audio-based digital biomarkers in diagnosing and managing respiratory diseases: a systematic review and bibliometric analysis.","authors":"Vivianne Landry, Jessica Matschek, Roger Pang, Meghana Munipalle, Kenneth Tan, Jill Boruff, Nicole Y K Li-Jessen","doi":"10.1183/16000617.0246-2024","DOIUrl":"10.1183/16000617.0246-2024","url":null,"abstract":"<p><p>Advances in wearable sensors and artificial intelligence have greatly enhanced the potential of digitised audio biomarkers for disease diagnostics and monitoring. In respiratory care, evidence supporting their clinical use remains fragmented and inconclusive. This study aimed to assess the current research landscape of digital audio biomarkers in respiratory medicine through a bibliometric analysis and systematic review (PROSPERO CRD 42022336730). MEDLINE, Embase, Cochrane Library and CINAHL were searched for references indexed up to 9 April 2024. Eligible studies evaluated the accuracy of sound analysis for diagnosing and managing obstructive (asthma and COPD) or infectious respiratory diseases, excluding COVID-19. A narrative synthesis was conducted, and the QUADAS-2 tool was used to assess study quality and risk of bias. Of 14 180 studies, 81 were included. Bibliometric analysis identified fundamental (<i>e.g.</i> \"diagnostic accuracy\"+\"machine learning\") and emerging (<i>e.g.</i> \"developing countries\") themes. Despite methodological heterogeneity, audio biomarkers generally achieved moderate (60-79%) to high (80-100%) accuracies. 80% of studies (eight out of ten) reported high sensitivities and specificities for asthma diagnosis, 78% (seven out of nine) reported high sensitivities and 56% (five out of nine) reported high specificities for COPD, and 64% (seven out of eleven) reported high sensitivity or specificity values for pneumonia diagnosis. Breathing and coughing were the most common biomarkers, with artificial neural networks being the most common analysis technique. Future research on audio biomarkers should focus on testing their validity in clinically diverse populations and resolving algorithmic bias. If successful, digital audio biomarkers hold promise for complementing existing clinical tools in enabling more accessible applications in telemedicine, communicable disease monitoring, and chronic condition management.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing an ageing cystic fibrosis population: challenges and priorities.","authors":"Freddy J Frost, Daniel G Peckham, Imogen C Felton, Joanna E Snowball, Robert D Gray, Andrew M Jones, Nicholas J Simmonds, Robert W Lord, Gregory Y H Lip, Hannah Chandler, Kevin Murphy, Damian G Downey, David N Sheppard, Jane C Davies, Jane Bull, Paula Sommer, Belinda Cupid, Lucy Allen, Jamie Duckers","doi":"10.1183/16000617.0261-2024","DOIUrl":"https://doi.org/10.1183/16000617.0261-2024","url":null,"abstract":"<p><p>The increasing life expectancy of people with cystic fibrosis (pwCF), largely driven by advancements in early diagnosis, multidisciplinary care and the recent introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies, is likely to herald a shift in the focus of care toward managing the complexities of ageing. This review highlights key challenges and research priorities for addressing the health needs of an ageing CF population. A growing body of evidence underscores the heightened risks of cancers, cardiovascular diseases and changing nutritional and metabolic profiles as pwCF age. CFTR modulators have improved clinical outcomes, but their effects on inflammation, immunity and long-term disease trajectories remain incompletely understood. Nutritional management, particularly the implications of obesity and body composition, poses new challenges, as does the potential accelerated ageing of immune and pulmonary systems in CF. Emerging issues such as menopause in females with CF, lifetime antimicrobial resistance and the interplay between chronic inflammation and ageing further complicate the care landscape. The review emphasises the urgent need for multidisciplinary research programmes that integrate clinical, patient and community perspectives. Leveraging established CF registries, clinical trial networks and collaborations with ageing research frameworks is critical to addressing these challenges. Ultimately, the goal is to ensure that pwCF not only live longer but also experience improved quality of life and holistic wellbeing as they realise the full benefits of therapeutic advances.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilation in the obese: physiological insights and management.","authors":"Claudio Rabec, Jean-Paul Janssens, Patrick B Murphy","doi":"10.1183/16000617.0190-2024","DOIUrl":"https://doi.org/10.1183/16000617.0190-2024","url":null,"abstract":"<p><p>Obesity can have profound adverse effects on the respiratory system, including an impact on pulmonary function, respiratory mechanics, respiratory muscle strength and endurance, gas exchange, control of breathing, and exercise capacity. Lung mechanics are modified by increased pleural pressure resulting from increased abdominal mass and subsequent peripheral airway occlusion and worsening of lung compliance due to reduced functional residual capacity without impairment of chest wall compliance. Arterial blood gases are frequently altered in these subjects and these abnormalities are directly proportional to body mass index. Mechanisms that may account for gas exchange abnormalities are multiple: ventilation/perfusion inequality (responsible for isolated hypoxaemia) and alveolar hypoventilation (responsible for so-called \"obesity hypoventilation syndrome\" (OHS)). Hypoventilation in obese patients results from a diversity of mechanisms, among which the two most frequently raised are mechanical limitation and blunted ventilatory drive. OHS is frequently underappreciated and diagnosis is frequently made during a first acute exacerbation. Obstructive sleep apnoea is a condition frequently associated with obesity and must be systematically screened for in this population because of its impact on morbidity and therapeutic management. Ventilatory management of these patients will depend on the patient's underlying situation, clinical presentation and physiology, including sleep study results; it may include continuous positive airway pressure or non-invasive ventilation. The goal of this narrative review is to provide a physiological-based overview of the impact of obesity on the respiratory system with a special focus on ventilatory management of patients with obesity-related respiratory disturbances.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in lower respiratory tract samples in the diagnosis of ventilator-associated pneumonia: a systematic review.","authors":"Emily Gromelsky Ljungcrantz, Sanna Askman, Fredrik Sjövall, Magnus Paulsson","doi":"10.1183/16000617.0229-2024","DOIUrl":"https://doi.org/10.1183/16000617.0229-2024","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is the most common intensive care unit-acquired infection, yet its diagnosis is complicated by the lack of reliable diagnostic criteria and validated biomarkers. Due to the compartmentalisation of the immune response, host proteins in respiratory tract samples are more likely than serum proteins to accurately identify VAP. However, a reliable biomarker is still missing and it is generally agreed that >90% sensitivity and specificity are required for the introduction of a VAP biomarker into clinical routine.</p><p><strong>Methods: </strong>A structured database search was performed to identify publications aimed at deriving or verifying human respiratory tract VAP biomarkers. The results were screened by two independent reviewers and summarised using statistical and narrative synthesis.</p><p><strong>Results: </strong>40 articles were identified, focusing on 29 unique biomarkers with clinical and microbiological diagnoses of VAP as the reference standard. The most frequently studied biomarker was soluble triggering receptor expressed on myeloid cell 1 (sTREM-1) (n=16), followed by various interleukins (n=7), neutrophil-related proteins (n=8) and amylase as a surrogate for microaspiration (n=4). The target accuracy of >90% specificity and sensitivity for VAP was reported in four publications on sTREM-1, one on pentraxin-3 (PTX3) and one on heparin-binding protein (HBP). Meta-analysis of sTREM-1 resulted in a sensitivity of 78% (95% CI 61-89%) and specificity of 76% (95% CI 49-91%).</p><p><strong>Discussion: </strong>This systematic review found that no biomarker can currently be recommended for clinical use due to performance below 90% specificity or sensitivity, or insufficient data (PTX3 and HBP). Accurate clinical phenotyping into VAP subcategories may enable the discovery of VAP biomarkers with higher accuracy.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 176","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}