Annals of the American Thoracic Society最新文献

{"title":"Providers Consistently Delay Extubation After Successful Spontaneous Breathing Trials: A Retrospective Cohort Study.","authors":"Anna K Barker, Rachel K Hechtman, Megan Acho, Michael W Sjoding","doi":"10.1513/AnnalsATS.202502-188OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202502-188OC","url":null,"abstract":"<p><strong>Rationale: </strong>Many patients who pass a spontaneous breathing trial (SBT) are not extubated, leaving them at risk for life-threatening ventilator-associated complications. Determining barriers to timely extubation may facilitate shorter overall durations of mechanical ventilation.</p><p><strong>Objectives: </strong>To identify the patient-related and patient-independent barriers to timely extubation within 6 hours of passing an SBT.</p><p><strong>Methods: </strong>We analyzed electronic health record data from adult patients on mechanical ventilation admitted to a medical or cardiac intensive care unit at an academic, tertiary-care center between 1/1/2015 and 12/31/2023. We utilized a mixed-effects multivariate logistic regression model to evaluate the association between timely extubation within 6 hours of first passing an SBT and fifteen potential reasons to delay extubation, accounting for clustering at the attending physician level.</p><p><strong>Results: </strong>Among 3,240 patients, 62.3% underwent timely extubation within 6 hours of first passing an SBT. Patients with delayed extubation experienced a median of 2.0 [IQR: 1.0-3.8] additional days on mechanical ventilation after passing an SBT, for a total of 3,930 days. This delay accounts for 32% of the total time on mechanical ventilation for the study population. Patients were less likely to have timely extubation if they underwent a procedure in the 24 hours after passing an SBT (average marginal effect [AME] -17.7%, 95% CI:-29.2 to -6.3), had lower levels of consciousness (AME -16.5%, 95% CI:-23.2 to -10.0), were on low (AME -12.9%, 95% CI:-19.2 to -4.8), or high dose vasopressors (AME -12.2%, 95% CI:-17.8 to -8.1), or had copious secretions (AME -8.7%, 95% CI:-13.3 to -4.1). However, 55% of patients with delayed extubation experienced none of these top five potential barriers. There was minimal physician variability in the decision to extubate after a successful SBT (median odds ratio: 1.10, 95% CI:1.02-1.78). The most frequent reason documented by respiratory therapists for not extubating a patient after passing an SBT was attending preference (43%).</p><p><strong>Conclusions: </strong>One in 3 patients remain on mechanical ventilation after passing their first SBT, with over half lacking an identifiable barrier to extubation. Future work should be pursued to address this, including consideration of unit-wide interventions to increase timely extubation attempts among patients without contraindications.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiology of Combined Pulmonary Fibrosis and Emphysema (CPFE) Among Mid-Atlantic Veterans.","authors":"Daniel M Guidot, Danielle Seaman, Roy A Pleasants, Joel C Boggan, Armando Bedoya, Aparna C Swaminathan, Matthew L Maciejewski, Bhavika Kaul, Robert M Tighe","doi":"10.1513/AnnalsATS.202408-882OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-882OC","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Combined pulmonary fibrosis and emphysema (CPFE) is a unique phenotype with important prognosis and management implications in patients with idiopathic pulmonary fibrosis (CPFE-IPF) and other forms of fibrotic interstitial lung disease (CPFE-fILD). However, the epidemiology of CPFE is not well characterized, creating a barrier to clinical research needed to advance our understanding and management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the incidence, prevalence, and long-term outcomes of CPFE among a regional cohort of Veterans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed records for Veterans in the Veterans Affairs Mid-Atlantic Health Care Network (includes North Carolina and Virginia) with International Classification of Disease (ICD)-9 codes for pulmonary fibrosis between January 1, 2008, and December 31, 2015. We stratified pulmonary fibrosis into IPF and fILD using diagnostic codes and chart review. We reviewed CT reports and classified cases as having CPFE according to documented emphysema; a thoracic radiologist overread a subset of scans for validation. We calculated annual incidence and prevalence of CPFE and compared characteristics between Veterans with CPFE and Veterans with fibrosis without emphysema using Chi-squared testing, Mann Whitney U testing, and paired t-tests. We used Kaplan-Meier and Cox models to determine overall survival from diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 2,414 Veterans with fibrotic ILD. Among 1,880 Veterans with IPF, 734 (39.0%) had CPFE-IPF; among 534 Veterans with fILD, 194 (36.3%) had CPFE-fILD. Agreement between CT reports and thoracic radiologist review was high (Kappa = 0.78). Annual CPFE prevalence ranged 71-100 per 100,000 Veterans, and incidence ranged 16-39 per 100,000 Veterans. CPFE was associated with male sex, lower BMI, greater tobacco history, higher FVC, reduced FEV1/FVC ratio, reduced DLCO, and increased oxygen utilization. CPFE was associated with increased mortality in unadjusted models. However, after adjustment for age, sex, and BMI, CPFE was not associated survival for both CPFE-IPF versus IPF without emphysema (HR 1.13, 95% CI 0.96-1.33) as well as CPFE-fILD versus fILD without emphysema (HR 1.16, 95% CI 0.82-1.63).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CPFE has high incidence and prevalence among Veterans with IPF and fILD and has a distinct phenotype with diagnostic and therapeutic implications. Further studies are merited investigating diagnosis, treatment considerations, and long-term impacts in CPFE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the incidence, prevalence, and long-term outcomes of CPFE among a regional cohort of Veterans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed records for Veterans in the Veterans Affairs Mid-Atlantic Health Care Network (includes North Carolina and Virginia) with International Classification of Disease (ICD)-9 codes for pulmonary fibrosis between Jan","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Interstitial Lung Abnormalities in Adult Smokers.","authors":"Fayez Kheir, Gary M Hunninghake, Yet H Khor, Brandon Pang, Anna Podolanczuk, Christopher J Ryerson, David A Schwartz, Kevin C Wilson","doi":"10.1513/AnnalsATS.202412-1256RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1256RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient Tachypnea of the Newborn and the Association with Preschool Asthma.","authors":"Mordechai Pollak, Moria Shapira, Dvir Gatt, Inbal Golan-Tripto, Aviv Goldbart, Guy Hazan","doi":"10.1513/AnnalsATS.202408-873OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-873OC","url":null,"abstract":"<p><p><b>Rationale:</b> Transient tachypnea of the newborn (TTN) is characterized by respiratory distress in neonates, resulting from delayed clearance of fetal lung fluid. Although traditionally considered a self-limited condition, recent studies have indicated a potential association between TTN and an increased risk for respiratory infections during infancy. <b>Objectives:</b> This study investigates the possible link between TTN and healthcare utilization for asthma during childhood. <b>Methods:</b> This retrospective, case-control study used nationwide electronic records from Clalit Healthcare Services, Israel. The study included term infants born between 2011 and 2018 who were diagnosed with TTN (TTN+) and a control group without TTN (TTN-). The primary outcomes were asthma-related healthcare utilization up to age 6 years. Propensity score matching was used to adjust for potential confounders. <b>Results:</b> The study included 645 children with TTN and 187,809 in the TTN- group. In prematching analysis, the TTN+ group had a higher incidence of cesarean delivery and male sex. Postmatching, demographic, and clinical differences were balanced. Children in the TTN+ group had significantly higher rates of emergency room visits for asthma (2.05 times higher; <i>P</i> value (<i>Pv</i>) < 0.001; 95% confidence interval [CI], 1.46-2.89), asthma diagnoses (38% increase; <i>Pv</i> < 0.001; 95% CI, 1.18-1.51), and prescriptions for short-acting β-agonists (28% increase; <i>Pv</i> = 0.002; 95% CI, 1.1-2.89) than control subjects. These associations remained significant after adjusting for confounders. <b>Conclusions:</b> The findings suggest that TTN may be associated with a higher risk of developing asthma in childhood. This study may enhance our understanding of the potential long-term respiratory implications of TTN and could inform clinical follow-up strategies for affected infants.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"881-886"},"PeriodicalIF":0.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Servo-ventilation for Treatment-emergent Central Sleep Apnea: The READ-ASV Registry.","authors":"Michael Arzt, Oliver Munt, Raphaela Kubeck, Holger Woehrle, Raphael Heinzer, Adam V Benjafield, Jean-Louis Pepin","doi":"10.1513/AnnalsATS.202502-210OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202502-210OC","url":null,"abstract":"<p><strong>Rationale: </strong>Treatment-emergent central sleep apnea (TE-CSA) is the most common indication for adaptive servo-ventilation (ASV). Evidence on the effects of TE-CSA treatment on quality of life (QoL) is limited.</p><p><strong>Objectives: </strong>To test the hypotheses that patients with TE-CSA who have cardiovascular disease (CVD) would be less symptomatic than those with CVD, and that the beneficial effects of ASV on QoL/sleepiness might be smaller in individuals with versus without CVD.</p><p><strong>Methods: </strong>ASV-naïve adults with TE-CSA and an ASV prescription were included in this analysis of the Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with ASV (READ-ASV). QoL (Functional Outcomes of Sleep Questionnaire [FOSQ] and daytime sleepiness (Epworth Sleepiness Scale [ESS]) were assessed at baseline and 12-month follow-up.</p><p><strong>Measurements and main results: </strong>Of 452 TE-CSA patients, 81% had CVD. Before treatment initiation FOSQ and ESS scores were better in those with versus without CVD. On ASV, in the CVD and no CVD subgroups, median [interquartile range] FOSQ score significantly increased (+0.72 [-0.20; +1.98], p<0.001 and +0.90 [-0.12; +2.29], p<0.001, respectively) and the ESS score significantly decreased (-2.00 [-5.00; 0.00], p<0.001 and -3.00 [-6.75; 0.00], p<0.001); improvement magnitude was similar in both subgroups (p=0.454 and p=0.120).</p><p><strong>Conclusions: </strong>The majority of individuals with TE-CSA and an ASV therapy prescription had CVD. Although those with TE-CSA and CVD were less symptomatic than those without CVD, ASV had a positive effect on QoL and sleepiness in these individuals, as well as those without CVD.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of ICU Patient-to-Clinician Ratios with Mortality Across Two US Health Systems.","authors":"Hayley B Gershengorn, George L Anesi, Vincent X Liu, Deena K Costa, Erich M Dress, Amy L Dzierba, Robert Fowler, Andrew A Kramer, Danny Lizano, Damon C Scales, Allan Garland, Hannah Wunsch","doi":"10.1513/AnnalsATS.202501-045OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-045OC","url":null,"abstract":"<p><p>Rationale The association of interprofessional team member workload with ICU outcomes is understudied. Objective To evaluate the association of patient-to-intensivist (PIR), patient-to-respiratory therapist (PRTR), and patient-to-clinical pharmacist (PpharmR) ratios with hospital mortality. Methods We conducted a retrospective study of adults admitted from the emergency department to an ICU with acute respiratory failure or sepsis within two US healthcare systems (2013-2018). Our primary exposures were patient-to-clinician ratios (PIR, PRTR, PpharmR) averaged over the ICU stay; our primary outcome was hospital mortality. We used multivariable mixed effects regression with patient-to-clinician ratios modeled as restricted cubic splines (4 knots). We primarily considered each exposure separately, then included all ratios together. Measurements and Main Results Our cohort included 45,036 patients (mean age 66.0 [standard deviation: 16.6] years, 23,420 [52.0%] male) across 27 ICUs within 24 hospitals. Of these, 29,326 (65.1%) had acute respiratory failure, 32,434 (72.0%) had sepsis, and 9,675 (21.5%) died in hospital. The average PIR was 9.3 (standard deviation, 3.6) and PRTR 7.9 (3.2); average PpharmR was 15.0 (5.5) among patients (n=8,950/45,036) in ICUs with clinical pharmacists (n=8/27). We found no significant association between average daily PIR (Wald test for all spline terms p=0.24) or PRTR (p=0.18) and hospital mortality in the full cohort; similarly, among patients in ICUs with pharmacists, no significant association of PpharmR with mortality (p=0.08). Models including ratios together yielded similar null results. Conclusions We did not identify an association of any average daily patient-to-clinician ratio with hospital mortality for US ICU patients with sepsis or respiratory failure.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Implementing a Standardized Risk Stratification and Triage Workflow for an Established Pulmonary Embolism Response Team (PERT).","authors":"Hussein J Hassan, Ryan G Belecanech, Peter J Leary, Gray R Lyons, Clifford R Weiss, Jennifer C Yui, Hamza Aziz, Bo S Kim, David N Hager, Todd M Kolb","doi":"10.1513/AnnalsATS.202412-1301OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1301OC","url":null,"abstract":"<p><p><b>Rationale:</b> The Pulmonary Embolism Response Team (PERT) model was developed to facilitate multi-specialty decision making and expedite therapeutic interventions for patients with pulmonary embolism (PE). PERT implementation has previously been associated with survival benefit in some studies, though specific workflow components that confer survival benefit have not been identified. <b>Methods:</b> As a quality improvement initiative, we implemented three specific workflow interventions to an existing PERT program at an academic medical center: 1) designated triage responsibility to a specific group of providers; 2) assigned guideline-based risk stratification to all calls at triage; and 3) established ICU admission guidelines based on risk stratification. We used the electronic medical record to review clinical outcomes for all PERT calls for 2-years after implementing the revised workflow and compared these to outcomes for the preceding 2-year period. We used logistic regression to compare the odds of in-hospital mortality before and after the workflow revision, with multiple models adjusted for clinically relevant variables. <b>Results:</b> During the study period (2019-2023) there were 420 unique patient PERT activations with confirmed PE; 253 patients were managed using the revised workflow and 167 patients were managed using the historical workflow. The proportion of patients meeting the primary endpoint of in-hospital death at 30-days following the workflow revisions was significantly lower than during the historical period (6.3% vs. 18.0%, P < 0.001). Logistic regression analysis demonstrated the revised PERT workflow to have a protective effect against in-hospital mortality (OR = 0.31, 95% CI 0.16-0.59; P < 0.001). This mortality benefit remained significant after adjustment for demographics, clinical factors, hemodynamic instability, Pulmonary Embolism Severity Index (PESI) Class, or Bova Stage. The workflow revisions were also associated with increased use of advanced therapies but did not change the proportion of patients with major bleeding or ICU or hospital length of stay. <b>Conclusions:</b> In an existing PERT program, implementation of three specific workflow revisions centered around risk stratification and level of care triage improved survival for patients with PE. These findings suggest that incorporation of a standardized approach and risk stratification are valuable components of the PERT response.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclassification of High-risk Smokers by FEV₁/FVC: Is It Worth a GOLD STAR?","authors":"Robert P Young, Zhitian Wang, Raewyn J Scott","doi":"10.1513/AnnalsATS.202411-1134RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1134RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Lung Cancer Disparities Calls for Another Look: Inclusion of Priority Populations in Screening Guidelines.","authors":"Randi M Williams, Lilianna Phan","doi":"10.1513/AnnalsATS.202501-032VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-032VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visit-to-visit FEV₁-variation and Mortality in WTC Exposed FDNY Rescue/Recovery Workers.","authors":"Kaat-Renée Deforce, Lies Lahousse, David G Goldfarb, David J Prezant, Michael D Weiden","doi":"10.1513/AnnalsATS.202501-093OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-093OC","url":null,"abstract":"<p><strong>Rationale: </strong>FEV₁ and its longitudinal change are mortality risk-factors. Visit-to-visit-FEV₁-variation is a risk-factor for death in cystic fibrosis but has not been studied in other cohorts.</p><p><strong>Objective: </strong>Assess if longitudinal visit-to-visit-FEV₁-variation is a mortality risk-factor in World Trade Center (WTC) exposed FDNY rescue/recovery workers.</p><p><strong>Methods: </strong>Linear mixed-effects regression of all post-9/11/2001 FEV₁ measurements defined time-effect on longitudinal-FEV₁-decline (FEV₁-slope) and its standard error (visit-to-visit-FEV₁-variation). Cox proportional hazards and logistic models adjusted for age and smoking assessed the association between FEV₁ related risk-factors and mortality. Receiver operating characteristic area under the curve (ROC-AUC) assessed predictive model performance.</p><p><strong>Measurements and main results: </strong>Among 11,745 workers with ≥3 FEV₁ measurements, 575 (4.9%) died. When all FEV₁-related risk-factors were combined, each 5 mL/year increase in visit-to-visit-FEV₁-variation increased mortality 2.1-fold (HR=2.14; 95%CI=1.84-2.48); each 10%predicted reduction in the last-longitudinal-FEV₁ increased mortality 15% (HR=1.15; 95%CI=1.09-1.21), but each 10ml/year longitudinal-FEV₁-decline was not associated with mortality (HR=1.04; 95%CI=0.99-1.10). The ROC-AUC of a fully adjusted multivariable cumulative mortality model was 0.82 (95%CI=0.80-0.84); for unadjusted visit-to-visit-FEV₁-variation, AUC was 0.80 (95%CI=0.78-0.82); for last-longitudinal-FEV₁ AUC was 0.61 (95%CI=0.59-0.64) and for longitudinal-FEV₁-decline AUC was 0.58 (95%CI=0.56-0.61). In the 1,988/11,745(16.9%) with high-WTC-exposure defined as arrival at the WTC-site before noon on 9/11/2001, the risk of high-visit-to-visit-FEV₁-variation (top-quartile, ≥10.35 ml/year) increased 25% (OR=1.25; 95%CI=1.12-1.40).</p><p><strong>Conclusions: </strong>Visit-to-visit-FEV₁-variation is a mortality risk-factor in FDNY rescue and recovery workers with greater accuracy for predicting cumulative mortality than either last-longitudinal-FEV₁ or longitudinal-FEV₁-decline. Further investigation in other cohorts is needed to assess the generalizability of this rarely studied mortality risk-factor.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}