American journal of respiratory and critical care medicine最新文献

{"title":"Plasma exchange for severe alveolar hemorrhage in antineutrophil cytoplasmic antibody-associated vasculitis: emulation of a target trial.","authors":"Anne-Claire Sanna, Ségolène Gendreau, Cyrielle Desnos, Romain Lombardi, Jolan Malherbe, Dimitri Titeca-Beauport, Florian Reizine, Guillaume Louis, Kladoum Nassarmadji, Julien Campagne, Jean-Philippe Martellosio, Alban Deroux, Eddine Bendiab, Valentin Coirier, Jennifer Catano, Marc Pineton De Chambrun, Maxime Samson, Clara Vigneron, Antoine Néel, Perrine Smets, Thylbert Deltombe, Benoit Brilland, Maxime Desgrouas, Olivier Simon, Stanislas Faguer, Stéphane Giorgiutti, Romain Paule, François Arrive, Ingrid Masson, Thomas Quéméneur, Cécile-Audrey Durel, Etienne de Montmollin, Jean-Pierre Quenot, François Perrin, Hervé Lobbes, Quentin Lajoye, Rafik Mesbah, Roderau Outh, Benjamin Thoreau, Adeline Lacraz, Carole Philipponnet, Damien Contou, Fabien Parazols, Florian Garo, Gauthier Blonz, Grégoire Ducoux, Halil Yildiz, Isabelle Rey, Ludovic Di Ascia, Nahema Issa, Pierre Le Guen, Viviane Queyrel, Rita Eid, Robin Arcani, Yurdagul Uzunhan, Xavier Puéchal, Raphaël Porcher, Nicolas de Prost, Benjamin Terrier","doi":"10.1093/ajrccm/aamaf122","DOIUrl":"10.1093/ajrccm/aamaf122","url":null,"abstract":"<p><strong>Rationale: </strong>Patients with severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-related diffuse alveolar hemorrhage (DAH) face high mortality. In the PEXIVAS trial, plasma exchange (PLEX) did not reduce death or end-stage kidney disease, but only 9% had severe DAH.</p><p><strong>Objectives: </strong>This study aimed to assess whether PLEX lowers mortality in patients with severe DAH.</p><p><strong>Methods: </strong>We emulated a target trial using retrospective data from a national multicenter cohort of patients with severe AAV-related DAH. The primary endpoint was 30-day mortality after intensive care unit (ICU) admission, analyzed using a Cox model adjusted for prespecified confounders.</p><p><strong>Measurements and main results: </strong>We included 184 patients (median age 66 [53-75] years; 51% female; 51% with granulomatosis with polyangiitis; 53% MPO (Myeloperoxydase)-ANCA positive). Of these, 144 (78.3%) received PLEX, and 40 (21.7%) did not. Baseline characteristics were similar, except for more severe renal impairment (creatinine 357 vs 171 µmol/L, P = .01) and more frequent cyclophosphamide use (77% vs 55%, P = .01) in the PLEX group. Severity at ICU admission (median Simplified Acute Physiology Score II score: 42) and mechanical ventilation needs (54%) were comparable between groups. At 30 days, overall survival was 85%. No significant difference in mortality was observed between the PLEX and no-PLEX groups: 30-day survival was 85% (95% CI, 81-90) with PLEX vs 88% (95% CI, 77-96) without (hazard ratio, 1.23; 95% CI, 0.57-3.89). Secondary outcomes were also similar.</p><p><strong>Conclusions: </strong>In this emulated target trial, PLEX did not reduce 30-day mortality in patients with severe AAV-related DAH.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"757-767"},"PeriodicalIF":19.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282055","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":"From Images to Outcomes: Artificial Intelligence-Based Standalone Risk Prediction in Idiopathic Pulmonary Fibrosis.","authors":"Linrui Xu, Mark G Jones, Fengming Luo","doi":"10.1093/ajrccm/aamag170","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag170","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832584","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":"Chronic Airways Assessment Test: Performance and Health Predictors in the AlphaNet Population.","authors":"Radmila Choate, Kristen E Holm, Robert A Sandhaus, David M Mannino, Charlie Strange","doi":"10.1093/ajrccm/aamag158","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag158","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832476","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":"A new anti-inflammatory treatment for bronchiectasis: a viewpoint on optimal dose selection for DPP1 inhibition in clinical practice.","authors":"James D Chalmers, Charles L Daley","doi":"10.1093/ajrccm/aamag096","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag096","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832408","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":"Blood transcriptomic signatures predict poor outcomes in drug-susceptible pulmonary TB in Brazil.","authors":"Simon C Mendelsohn, Bruno B Andrade, Mariana Araújo-Pereira, Gustavo C Amorim, Mzwandile Erasmus, Alice M S Andrade, Michelle Fisher, Marina C Figueiredo, Vanessa M Muwanga, Afranio L Kritski, Marcelo Cordeiro-Santos, Valeria C Rolla, Mark Hatherill, Timothy R Sterling, Thomas J Scriba","doi":"10.1093/ajrccm/aamag156","DOIUrl":"10.1093/ajrccm/aamag156","url":null,"abstract":"<p><strong>Background: </strong>Non-sputum biomarkers to monitor tuberculosis treatment and predict poor outcomes are lacking. We evaluated host-blood transcriptomic signatures for treatment monitoring and prognosis (death, treatment failure, recurrence) in adults with pulmonary tuberculosis.</p><p><strong>Methods: </strong>Adults with culture-confirmed, drug-susceptible pulmonary tuberculosis were enrolled at five Brazilian sites. Whole-blood PAXgene samples were collected at baseline, month 2 (M2), and end of treatment (EoT). Treatment failure was defined as sputum culture positivity at month 5 or later. Participants were followed for 24 months from treatment initiation for clinical or microbiological tuberculosis recurrence. Unfavourable outcomes were matched ∼1:3 to recurrence-free cure. Twenty-two published blood transcriptomic signatures were measured by microfluidic RT-qPCR and benchmarked against the WHO Target Product Profile (TPP) criteria.</p><p><strong>Main results: </strong>We matched 263 participants with recurrence-free cure to 33 with treatment failure, 24 who died (tuberculosis/unknown cause), and 9 with recurrence. Signature scores generally declined from baseline to EoT. Multiple signatures measured at baseline and M2 predicted recurrence (AUC range 0.71-0.91), with waning performance when measured at EoT (AUC range 0.42-0.89). Against the WHO TPP, 2/22 signatures met minimum criteria at baseline, 13/22 at M2, and none at EoT. Prediction of treatment failure was poor across timepoints (AUC < 0.70). In contrast, several signatures measured at baseline predicted death during treatment or follow-up (AUC ≥ 0.80).</p><p><strong>Conclusions: </strong>Blood transcriptomic signatures tracked treatment response and predicted recurrence and death, meeting WHO TPP benchmarks at baseline and M2. These findings support prospective, biomarker-guided trials to individualise tuberculosis therapy-shortening regimens for early responders and intensifying care for high-risk patients.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832486","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":"Race and Ethnicity in Lung Disease.","authors":"Brandon Luu, Marita Staunton, Craig Bryan, Sebastián Rodríguez-Llamazares","doi":"10.1093/ajrccm/aamag157","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag157","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832823","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":"10 mL/kg vs 20 mL/kg fluid bolus in pediatric septic shock: a randomized clinical trial.","authors":"Karthi Nallasamy, Jerin C Sekhar, Jaspreet Kaur, Arun Bansal, Suresh Kumar Angurana, Muralidharan Jayashree","doi":"10.1093/ajrccm/aamag113","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag113","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832419","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":"Long-term effectiveness and safety of CFTR modulators and their impact on the lives of people with CF.","authors":"Mirjam Stahl, Marcus A Mall, Bonnie Ramsey, Kathleen J Ramos","doi":"10.1093/ajrccm/aamag149","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag149","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832803","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":"Cost-Effectiveness of Community Tuberculosis Screening in South Africa.","authors":"Julie N Deleger, S Nazanin Khatami, Michelle Jones, Mohammad S Jalali, A David Paltiel, Emily B Wong, Grady Florance, Kenneth A Freedberg, Robin Wood, C Robert Horsburgh, Krishna P Reddy","doi":"10.1093/ajrccm/aamag163","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag163","url":null,"abstract":"<p><strong>Rationale: </strong>The World Health Organization recommends community-based tuberculosis active case finding using digital chest radiography with computer-aided detection (dCXR/CAD) and/or molecular diagnostics, but clinical and economic outcomes are unclear.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of community-based tuberculosis screening strategies in South Africa.</p><p><strong>Methods: </strong>Using a microsimulation model, we evaluated three symptom-agnostic screening strategies among adult people without HIV (PWoH) and people with HIV (PWH): (1) No Screening; (2) sputum Xpert Ultra (Xpert); and (3) dCXR/CAD followed by confirmatory sputum Xpert (dCXR + Xpert). Base case tuberculosis prevalence was 0.64%-1.23%. Sensitivity/specificity/cost for dCXR/CAD were 77-90%/65-73%/$3.55; for Xpert Ultra, they were 69-91%/98-99%/$15.24. Model outcomes included life-years, costs, and incremental cost-effectiveness ratios (ICERs) (<$3,000/year-of-life saved [YLS] considered cost-effective). We conducted sensitivity analysis around key parameters, including test sensitivity, specificity, and cost.</p><p><strong>Measurements and main results: </strong>In the base case, Xpert identifies the most individuals with tuberculosis but produces the most false-positives and highest costs. Compared to Xpert, dCXR + Xpert identifies ∼13% fewer individuals with tuberculosis while decreasing screening costs by ∼45%. Given base case performance characteristics, at the lifetime horizon, dCXR + Xpert is cost-effective (ICER $610/YLS) while Xpert is not (ICER $3,460/YLS). dCXR + Xpert remains cost-effective relative to No Screening unless tuberculosis prevalence (PWoH/PWH) is ≤ 0.15%/0.45%, dCXR/CAD sensitivity is (PWoH/PWH) ≤ 20%/10%, dCXR/CAD cost is ≥$34.00, Xpert Ultra cost is ≥$135.00, or linkage to tuberculosis care is ≤ 15%.</p><p><strong>Conclusion: </strong>Digital chest radiography with computer-aided detection followed by confirmatory sputum Xpert Ultra would likely be a cost-effective strategy for tuberculosis screening in South Africa.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832498","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":"Geographic Disparities in COPD Inhalers by Rurality, Drive Time, and Neighborhood Disadvantage.","authors":"Arianne K Baldomero, R Adams Dudley, Chris H Wendt","doi":"10.1093/ajrccm/aamag159","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag159","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832617","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}