BMC Pulmonary Medicine最新文献

{"title":"Progressive pulmonary fibrosis criteria predict mortality in treated idiopathic pulmonary fibrosis: a prospective cohort study.","authors":"Yu-Cheng Wu, Chen-Yu Wang, Yi-Luen Shen, Chiann-Yi Hsu, Yi-Hsuan Yu, Pin-Kuei Fu","doi":"10.1186/s12890-026-04501-x","DOIUrl":"10.1186/s12890-026-04501-x","url":null,"abstract":"<p><strong>Background: </strong>The 2022 ATS/ERS/JRS/ALAT criteria for progressive pulmonary fibrosis (PPF) were developed for fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (IPF). Whether this multidimensional framework has prognostic value in patients with treated IPF remains uncertain. We evaluated the prevalence of PPF-defined progression and its association with mortality in patients with IPF receiving antifibrotic therapy.</p><p><strong>Methods: </strong>This prospective cohort study included patients with multidisciplinary discussion-confirmed IPF enrolled in the Registry of Interstitial Lung Disease (REGILD) between 2018 and 2022. Disease progression was assessed one year after initiation of antifibrotic therapy using the 2022 PPF criteria. The primary outcome was 3-year all-cause mortality. Cox regression and nested Cox model analyses were performed to identify prognostic factors and evaluate incremental prognostic value beyond the GAP score.</p><p><strong>Results: </strong>Ninety patients were included, of whom 50 (55.6%) fulfilled PPF criteria after one year of antifibrotic therapy. During a median follow-up of 3.6 years, 28 patients (31.1%) died. Three-year mortality was significantly higher in patients with PPF-defined progression than in those with stable disease (46.0% vs. 12.5%, p = 0.001). In multivariable analysis, lower baseline body mass index (BMI) (HR 0.87, 95% CI 0.78-0.96, p = 0.006) and PPF-defined progression (HR 3.39, 95% CI 1.23-9.34, p = 0.018) were independently associated with mortality. Addition of PPF-defined progression to a model containing the GAP score significantly improved model fit (Δχ² = 5.610, p = 0.018).</p><p><strong>Conclusions: </strong>PPF-defined progression and lower baseline BMI were independently associated with mortality in patients with IPF receiving antifibrotic therapy. PPF-defined progression provided incremental prognostic information beyond the GAP score, suggesting that assessment of longitudinal disease trajectory may complement conventional baseline risk stratification in treated IPF.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interpretable prognostic model for early unfavorable outcomes after bronchiectasis surgery.","authors":"Yichen Hou, Qibatu Wu, Long Ma, Liwei Zhang, Yanchao Deng","doi":"10.1186/s12890-026-04508-4","DOIUrl":"10.1186/s12890-026-04508-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bronchiectasis is a heterogeneous airway disorder characterized by irreversible bronchial dilatation, chronic sputum production, recurrent infections, and acute exacerbations. Although lung resection remains a valuable option for patients with localized, refractory disease despite optimized medical therapy, early postoperative recovery varies substantially among individuals. An interpretable tool for individualized risk stratification remains lacking in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study enrolled patients who underwent bronchiectasis-related lung resection at our center between January 2020 and August 2025 (n = 142). The primary endpoint was a composite outcome assessed at approximately 1 month postoperatively. A favorable outcome was defined as the absence of Clavien-Dindo grade II or higher complications in conjunction with a Quality of Life Questionnaire-Bronchiectasis Respiratory Symptoms Scale (QoL-B-RSS) score &gt; 50; all other cases were classified as unfavorable outcomes. Candidate predictors (n = 40) were prespecified before model development. Elastic Net-penalized logistic regression was employed as the primary modeling approach, based on which a nomogram was constructed. Nested cross-validation was used for hyperparameter tuning and internally unbiased performance evaluation. Out-of-fold (OOF) predicted probabilities were used to assess discrimination (area under the curve [AUC]), overall accuracy (Brier score), calibration, and clinical utility via decision curve analysis (DCA). A random forest (RF) model, using identical outer-fold partitions, was developed as a direct comparator, and a conventional multivariable logistic regression model was additionally fitted using the predictors retained in the primary model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The incidence of early unfavorable outcomes was 57.7% (82/142). The final Elastic Net model retained five predictors: pCO₂, left ventricular ejection fraction (LVEF), forced expiratory volume in 1 s as a percentage of predicted (FEV1%pred), maximal voluntary ventilation as a percentage of predicted (MVV%pred), and total Bronchiectasis Severity Index (BSI) score. Internal OOF validation yielded an AUC of 0.820 and a Brier score of 0.173 for the primary model, compared with an AUC of 0.831 and a Brier score of 0.179 for the RF model. Overall, the RF model did not demonstrate a meaningful performance advantage over the primary model. Calibration analysis indicated good agreement between predicted and observed probabilities, and DCA suggested potential net clinical benefit across a range of threshold probabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This internally validated Elastic Net-based nomogram showed good discrimination, acceptable calibration, and potential clinical utility for predicting early unfavorable outcomes after bronchiectasis surgery. Based on routinely available preoperative variables, the model may provide","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers associated with post-operative pneumonia: a systematic review and meta-analysis.","authors":"Fiona Howroyd, Amanda Veiga Sardeli, Fang Gao Smith, Tonny Veenith, Niharika A Duggal, Zubair Ahmed","doi":"10.1186/s12890-026-04486-7","DOIUrl":"10.1186/s12890-026-04486-7","url":null,"abstract":"<p><strong>Background: </strong>Post-operative pneumonia is a commonly occurring surgical complication associated with poor patient outcomes. This study aimed to synthesise pre-operative and post-operative blood-based biomarkers associated with post-operative pneumonia.</p><p><strong>Methods: </strong>Electronic databases were searched up to April 14th, 2026. Primary studies investigating blood-based biomarkers in adults hospitalised after surgery were included. Meta-analysis was performed using the random effects model to compare pooled data for pneumonia and no-pneumonia groups using standardised mean difference. Risk of bias was assessed using the ROBINS-E tool.</p><p><strong>Results: </strong>Thirty-seven studies (n = 15,842 patients) were included, with an overall pneumonia rate of 17.8% [15.8-20.0%]. One hundred and fifteen biomarkers were identified. Meta-analysis identified that patients who developed post-operative pneumonia had significantly lower platelet-to-neutrophil ratio (p < 0.0001), red blood cell count (p = 0.001), haemoglobin (p = 0.002), albumin (p = 0.005) and lymphocyte count (p = 0.008) and significantly higher monocyte-to-lymphocyte ratio (p < 0.0001), systemic immune inflammation index (p < 0.001), systemic inflammatory response index (p < 0.0001) and blood urea nitrogen (p = 0.0001) at pre-operative baseline, compared to those without pneumonia. Patients who developed post-operative pneumonia were associated with significantly higher procalcitonin (PCT) at post-operative day one (p = 0.03), two (p = 0.0001), three (p = 0.0004) and six (p < 0.0001); higher C-Reactive Protein (CRP) at day two (p = 0.02), four (p < 0.0001) and five (p < 0.0001); higher interleukin (IL)-6 at day three (p = 0.001) and four (p = 0.0002); and higher white blood cell (WBC) count at day three (p = 0.01) and day four (p = 0.001) post-operatively, compared to those without pneumonia. In addition, pre-operative CRP was associated with mortality within the patients who later developed post-operative pneumonia (r = 0.70, p = 0.0009).</p><p><strong>Conclusions: </strong>The results identify blood-based biomarker signals associated with post-operative pneumonia. However, interpretation is limited by heterogeneous pneumonia definitions and inconsistent reporting of diagnosis timing across studies. The certainty of evidence is therefore limited, and thus these biomarkers cannot currently be used for prediction or diagnosis in clinical practice. Further high‑quality, prospective studies are required to establish clinically meaningful thresholds.</p><p><strong>Protocol registration: </strong>PROSPERO: CRD42024570654.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated host vulnerability score is associated with survival in advanced NSCLC treated with nivolumab: a PET/CT-based real-world study.","authors":"Vali Aliyev, Murad Guliyev, Mehmet Cem Fidan, Zeliha Birsin, Murat Günaltılı, Emir Çerme, Selin Cebeci, Hamza Abbasov, Said Erkam Bıyıkoğlu, Onur Erdem Şahin, Muhammet Sait Sağer, Nebi Serkan Demirci, Özkan Alan","doi":"10.1186/s12890-026-04496-5","DOIUrl":"10.1186/s12890-026-04496-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical outcomes in advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors remain heterogeneous, and simple prognostic tools for patient stratification are limited. We aimed to evaluate a multidimensional host vulnerability score integrating systemic inflammation, nutritional status, and skeletal muscle depletion in patients receiving second-line nivolumab in a real-world setting.</p><p><strong>Methods: </strong>In this retrospective study, 110 patients with advanced NSCLC treated with second-line nivolumab were included. A composite score was constructed using neutrophil-to-lymphocyte ratio (NLR), serum albumin, and skeletal muscle index (SMI) derived from pretreatment PET/CT. Patients were stratified into lower-risk (score 0-1) and higher-risk (score 2-3) groups. Survival outcomes were assessed using Kaplan-Meier analysis, Cox proportional hazards models, and model discrimination analyses.</p><p><strong>Results: </strong>High-risk patients had significantly shorter progression-free survival (median 3.4 vs. 5.9 months; HR 1.68, 95% CI 1.10-2.59; p = 0.017) and overall survival (median 7.2 vs. 14.5 months; HR 2.08, 95% CI 1.30-3.31; p = 0.002) compared with the low-risk group. In model comparison analyses, the ordinal composite score showed the clearest improvement in prognostic discrimination for overall survival, whereas its incremental value for progression-free survival was more modest.</p><p><strong>Conclusion: </strong>A multidimensional host vulnerability score integrating inflammatory, nutritional, and body composition domains was associated with survival outcomes in advanced NSCLC treated with nivolumab. This score may support real-world prognostic risk stratification, particularly for overall survival, but requires prospective and external validation before clinical implementation.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic value of the injury-inflammation-fibrosis serum biomarker panel (KL-6, SAA, YKL-40) in lung cancer treatment-associated ILD.","authors":"Shuilian Wu, Jing Jin, Lingli Wu, Xiangjiang Zeng, Qiang Hou, Lei Shu","doi":"10.1186/s12890-026-04479-6","DOIUrl":"10.1186/s12890-026-04479-6","url":null,"abstract":"<p><strong>Objective: </strong>Cancer therapy-related interstitial lung disease (CT‑ILD) is a serious and potentially fatal complication in lung cancer patients treated with radiotherapy or antineoplastic agents, characterized by high mortality and limited treatment options. Early recognition remains challenging due to the absence of sensitive and specific biomarkers. This study aimed to establish a tripartite serum biomarker panel-KL‑6 (lung injury), SAA (inflammation), and YKL‑40 (fibrosis)-representing the \"injury-inflammation-fibroproliferation\" axis, and to evaluate its diagnostic and prognostic value for CT‑ILD.</p><p><strong>Methods: </strong>In this single-center observational case-control study, we consecutively enrolled hospitalized patients with histologically confirmed lung cancer who underwent thoracic radiotherapy and/or systemic anti-neoplastic therapy between January 2024 and June 2025. Based on imaging findings, patients were classified into the ILD group (n = 73) or N‑ILD group (n = 67). Serum KL‑6, SAA, and YKL‑40 were quantified alongside conventional inflammatory markers (CRP, IL‑6). ROC analysis evaluated diagnostic performance. Logistic regression identified independent ILD correlates. Subgroup analyses delineated etiological differences, comparing radiotherapy-induced ILD (RT‑ILD) with drug-induced ILD (DI‑ILD), and further explored their associations with clinical benefit as an exploratory endpoint.</p><p><strong>Results: </strong>KL‑6, SAA, YKL‑40, and IL‑6 were significantly elevated in ILD compared with N‑ILD (all P < 0.05). ROC analysis yielded AUCs of 0.764 for KL‑6, 0.880 for SAA, and 0.718 for YKL‑40, with optimal cut‑offs of 349.5 U/L, 18.7 mg/L, and 71.65 ng/mL, respectively (all P < 0.001). Independent correlates of ILD included SAA > 18.7 mg/L (OR = 32.321), KL‑6 > 349.5 U/L (OR = 5.842), and YKL‑40 > 71.65 ng/mL (OR = 5.250). In the overall cohort, the combined model (KL-6 + SAA + YKL-40) showed good calibration (Hosmer-Lemeshow P > 0.05) but did not significantly outperform SAA alone in AUC (DeLong test, P > 0.05). SAA maintained high diagnostic value in both RT-ILD (AUC = 0.834) and DI-ILD (AUC = 0.891) subgroups. In exploratory analyses, higher KL-6 levels and the presence of multiple metastases were associated with a lack of durable clinical benefit (both P < 0.05).</p><p><strong>Conclusion: </strong>The KL‑6/SAA/YKL‑40 biomarker panel demonstrates exploratory utility for early CT‑ILD detection. SAA alone shows high diagnostic performance, while the combined model offers acceptable calibration. The panel may support risk stratification and timely individualized management during chemo‑/radiotherapy.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between corticosteroid exposure during chest-tube placement and pleurodesis failure in malignant pleural effusion: a retrospective analysis.","authors":"Kosuke Dobashi, Yuichiro Takeshita, Yoshikazu Utsu, Yuta Otake, Reiya Kono, Keita Katsuyama, Yuri Suzuki, Mitsuhiro Abe, Jiro Terada","doi":"10.1186/s12890-026-04480-z","DOIUrl":"https://doi.org/10.1186/s12890-026-04480-z","url":null,"abstract":"<p><strong>Background: </strong>Clinical evidence of the impact of corticosteroid use and pleurodesis outcomes in malignant pleural effusion (MPE) remains limited. This study aimed to explore the relationship between corticosteroid exposure and pleurodesis outcomes in patients with MPE.</p><p><strong>Methods: </strong>This retrospective cohort study included 138 consecutive patients with MPE who received pleurodesis between April 2012 and September 2024. Based on pleurodesis outcomes, the 138 patients were divided into two groups as follows: success group (n = 99) and failure group (n = 39). Failure was defined as recurrent pleural effusion within 28 days after chest-tube removal, tube removal owing to intolerance, or death with chest-tube in situ; the other outcomes were defined as constituting success. Patients who received systemic corticosteroids during chest-tube usage were classified as steroid users. The cumulative corticosteroid dose was calculated as the prednisolone (PSL)-equivalent dose multiplied by the duration of steroid administration.</p><p><strong>Results: </strong>Multivariate analysis of 138 patients demonstrated that poor performance status (PS), such as PS 3-4, and multi-day steroid use during chest-tube usage were associated with pleurodesis failure in patients with MPE. Furthermore, a subgroup analysis of 15 patients who received steroids during chest-tube usage showed that the cumulative steroid dosage was positively correlated with chest-tube usage duration.</p><p><strong>Conclusions: </strong>In this retrospective cohort study, multi-day corticosteroid exposure during chest-tube placement was associated with pleurodesis failure in patients with MPE. These findings should be considered hypothesis-generating and interpreted with caution because of potential confounding factors. Further prospective multicenter studies are needed to clarify this association.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in mortality with chronic obstructive pulmonary disease as the underlying cause and chronic kidney disease as a contributing cause among US adults, 1999-2020: a CDC WONDER analysis.","authors":"Chengying Zhu, Guoxin Zhang","doi":"10.1186/s12890-026-04499-2","DOIUrl":"10.1186/s12890-026-04499-2","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) frequently coexist, yet mortality trends in patients with both conditions remain poorly characterized.</p><p><strong>Methods: </strong>Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates from 1999 to 2020 for adults aged ≥ 25 years with COPD (ICD-10: J40-J44) as the underlying cause and CKD (N18) as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using 2000 US standard population. Trends were assessed via Joinpoint regression, with stratifications by sex, race/ethnicity, age, urbanization, census regions, and state.</p><p><strong>Results: </strong>Deaths increased from 1,405 in 1999 to 5,277 in 2020. The AAMR increased from 0.79 in 1999 to 1.96 in 2020. The overall average annual percent change (AAPC) was + 4.71% (95% CI: 3.06-6.38). Mortality rates were higher in males (AAMR: 2.41) than females (AAMR: 1.65), though females had faster increases (AAPC + 5.86% vs. + 3.42%). The 85 + age group had the highest rates (27.98 per 100,000 population) and fastest growth (APC + 6.43%). non-Hispanic (NH) White individuals exhibited the steepest increase (AAPC + 5.25%), while NH Black individuals had no significant trend (AAPC - 0.22%). Nonmetropolitan areas had higher AAMRs (2.68) compared to metropolitan areas (1.82). Regionally, the Midwest recorded the highest AAPC (+ 5.32%) and 2020 AAMR (2.42). State-level AAPCs ranged from 1.5% to 7.0%.</p><p><strong>Conclusion: </strong>Rising COPD-related mortality among adults with CKD highlights a need for integrated pulmonary-renal care, targeted interventions for high-risk populations, and policies addressing rural healthcare access and environmental risk factors. These estimates reflect deaths certified with COPD as the underlying cause and CKD as a contributing cause, and therefore do not represent mortality among all individuals with coexisting COPD and CKD.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectorated bronchial casts revealing lymphatic plastic bronchitis due to thoracic duct agenesis: case report.","authors":"Nela Stastna, Pavlina Lisa","doi":"10.1186/s12890-026-04432-7","DOIUrl":"https://doi.org/10.1186/s12890-026-04432-7","url":null,"abstract":"<p><strong>Background: </strong>Plastic bronchitis is a rare disorder most often linked to aberrant lymphatic drainage or congenital and acquired cardiac anomalies. In patients with lymphatic flow abnormalities, leakage or anomalous lymphatic-bronchial communications can allow lymphatic fluid to enter the airways, where it solidifies into gelatinous or rubbery bronchial casts that may obstruct airflow and are typically expectorated.</p><p><strong>Case presentation: </strong>A 49-year-old man presented with chronic, recurrent expectoration of pale bronchial casts accompanied by episodic dyspnea and intermittent fever. A chest CT demonstrated right-lower-lobe ground-glass opacities, interstitial changes with a lymphatic distribution pattern, and mediastinal lymphadenopathy. Bronchoscopy was unremarkable, and sputum microbiology was negative. Pulmonary function testing showed a mild obstruction. Cytologic evaluation of an expelled cast revealed mucus with fibrin, erythrocytes, macrophages, lymphocytes, and neutrophils. MR lymphangiography identified a congenital absence of the thoracic duct. Abdominal lymph drained through two markedly dilated lymphatic vessels converging in the retromediastinum and supplying predominantly right-sided pulmonary lymphatics, with a normal left-sided system. These findings established the diagnosis of lymphatic plastic bronchitis due to thoracic duct agenesis. The patient declined lymphatic intervention aimed at occluding the subdiaphragmatic channels, and his condition remains chronically persistent.</p><p><strong>Conclusion: </strong>This case highlights an unusual and unexpected presentation of bronchial cast formation. While bronchial casts are typically identified and removed bronchoscopically-often preserving the morphology of the bronchial tree-in this patient the casts were not amenable to bronchoscopic removal, and were instead repeatedly expectorated as cohesive clots. Spontaneous expectoration of bronchial casts is a rare phenomenon and underscores the variability in clinical presentation and management challenges of this condition.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental prognostic value of the systemic immune‑inflammation index, pan‑immune‑inflammation value, and modified glasgow prognostic score for severity assessment and outcome prediction in community‑acquired pneumonia.","authors":"Yunkui Li, Yue Hu, Liming Fan, Yuanyuan Wu, Wei Xiao","doi":"10.1186/s12890-026-04422-9","DOIUrl":"10.1186/s12890-026-04422-9","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) constitutes a significant cause of hospital admissions and mortality globally. Accurate assessment of CAP severity and prognosis is crucial for optimizing treatment strategies. This study investigates the utility of the Systemic Immune-Inflammation Index (SII), Pan-Immune Inflammation Value (PIV), and modified Glasgow Prognostic Score (mGPS) in evaluating CAP severity and predicting patient outcome.</p><p><strong>Methods: </strong>Conducted a retrospective analysis of our medical records of 1879 patients with CAP who were admitted between January 2021 and December 2023. The patients were categorized into a mild disease group (n = 595, 31.66%) and a severe disease group (n = 1284, 68.33%) using the Pneumonia Severity Index (PSI). Additionally, based on the prognosis during the first 28 days, the patients were divided into a good prognosis group (n = 1618, 86.11%) and a poor prognosis group (n = 261, 13.89%) based on their prognosis within the first 28 days. The mean values of the SII, PIV, and mGPS were calculated and statistically analyzed to determine their association with disease severity and prognosis. Model comparison with the PSI and assessment of incremental prognostic value were performed using hierarchical logistic regression and receiver operating characteristic curve analyses.</p><p><strong>Results: </strong>In our study, we found that the levels of SII and PIV are much higher in patients with severe CAP. These two indices have a positive correlation with bad outcomes (SII: rho = 0.198, P < 0.001; PIV: rho = 0.154, P < 0.001). Multivariate logistic regression identified mGPS as the strongest independent predictor of severe CAP (OR = 18.342, P < 0.001), along with respiratory rate, diastolic blood pressure, and PIV. For poor prognosis (28-day mortality), independent predictors included BMI, cardiovascular disease, PSI score, mGPS (OR = 26.512, P < 0.001), heart rate, respiratory rate, body temperature, diastolic blood pressure, SII, and PIV. ROC analysis showed that SII (AUC = 0.665), PIV (AUC = 0.628), and mGPS (AUC = 0.677) exhibited moderate individual predictive accuracy for 28‑day mortality; however, adding these indices to the PSI improved the AUC from 0.672 to 0.712.</p><p><strong>Conclusion: </strong>SII, PIV, and mGPS correlate with CAP severity and 28‑day outcomes. Although their standalone discriminative ability is only moderate, they provide incremental prognostic information when combined with established scores such as the PSI. These inexpensive, routinely available biomarkers may serve as adjunctive tools to enhance risk stratification, and their integration with clinical variables modestly improves prediction of adverse outcomes.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnosis and prognosis role of miR-155 in neonatal acute respiratory distress syndrome.","authors":"Yangping Zhou, Yuan Yu, Jiangshan Wang, Meina Sun, Liang Bao, Xin Du, Juan Ouyang","doi":"10.1186/s12890-026-04439-0","DOIUrl":"10.1186/s12890-026-04439-0","url":null,"abstract":"<p><strong>Background: </strong>Neonatal acute respiratory distress syndrome (NARDS) can cause respiratory failure in newborns and even pose a threat to their lives, causing a heavy financial burden on families.</p><p><strong>Aim: </strong>This study aims to explore the potential role of miR-155 as a diagnostic marker and prognostic predictor for NARDS.</p><p><strong>Methods: </strong>This study included 100 non-NARDS newborns and 100 NARDS newborns. The plasma miR-155 expression was measured by RT-qPCR. The ROC curve was used to analyze the diagnostic efficacy of miR-155 alone and the combined diagnostic efficacy of PT, APTT, FIB, and CRP. The correlation between clinical indicators and miR-155 expression was analyzed by the chi-square test. The general clinical information of NARDS neonates with different severity degrees and prognosis was compared. Multivariate logistic regression was used to identify the risk factors for NARDS.</p><p><strong>Results: </strong>The plasma miR-155 level was elevated in NARDS newborns. miR-155 may serve as a promising biomarker in the diagnosis of NARDS. The value of the multi-factor combined diagnosis was significantly improved. 1-minute Apgar score, PT, APTT, and CRP level were statistically related to the miR-155 expression. Abnormal FIB level and the miR-155 expression were independent risk factors for NARDS. The more severe NARDS newborns have poorer coagulation function, stronger inflammatory response, and higher miR-155 level. A higher level of miR-155 was observed in NARDS newborns with a poorer prognosis.</p><p><strong>Conclusion: </strong>The plasma miR-155 level is upregulated in NARDS, and miR-155 may be a potential diagnostic marker for NARDS. NARDS newborns with miR-155 high expression have a poor prognosis.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}