Annals of the American Thoracic Society最新文献

{"title":"Preoxygenation and High Flow Oxygen Therapy During Bronchoscopy Under Procedural Sedation in Patients with Central Airway Obstruction.","authors":"Jens Gottlieb, Thomas Fuehner","doi":"10.1513/AnnalsATS.202504-415LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202504-415LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042555","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":"Reply to Li and Jiang: Comment on Long-Term Pulmonary Sequelae Following Severe COVID-19: Reflections on Study Design and Interpretation.","authors":"Matthew R Baldwin, Christine Kim Garcia","doi":"10.1513/AnnalsATS.202507-822LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202507-822LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042540","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":"How Adherence Shapes Persistence in IPF Treatment: A Call for Real-World Insight.","authors":"Joaquín Borrás-Blasco, Alejandro Valcuende-Rosique, Silvia Cornejo","doi":"10.1513/AnnalsATS.202506-645LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-645LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042567","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":"Morning Larks and Night Owls: Considering Chronotype in Evaluation of Patients with Pulmonary Hypertension.","authors":"Cyrus Vahdatpour, Shiza Virk, Haocheng Ding, Samuel Epstein, Kirk Jones, Omar Alneser, Muhammad Albanna, Christina Eagan, Katherine Fu, Olufemi Osunnuga, Lauran Zeineddine, Jeffrey S Annis, Elnaz Ebrahimi, Ali Ataya, Saminder Kalra, Evan L Brittain, Megan M Lowery, Susheela Hadigal, Karyn A Esser, Zhiguang Huo, Andrew J Bryant","doi":"10.1513/AnnalsATS.202502-190OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202502-190OC","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is a systemic illness with increasingly subtle disease manifestations including sleep disruption. Patients with PH are at increased risk for disturbances in circadian biology, although to date there is no data on \"morningness\" or \"eveningness\" in pulmonary vascular disease.</p><p><strong>Research questions: </strong>Our group studied circadian rhythms in PH patients based upon chronotype analysis, to explore whether there is a link between circadian parameters and physiologic risk-stratifying factors to inform novel treatment strategies in patients with PH?</p><p><strong>Study design and methods: </strong>We serially recruited participants from July 2022 to March 2024, administering in clinic the Munich Chronotype Questionnaire (MCTQ). We then compared free-day sleep measurements in PH and bed-partner controls (BPCs), investigating associations with survival predictors. In exploratory analysis we looked for associations between known single nucleotide polymorphism (SNP) variants of core clock genes and cardiopulmonary hemodynamics. Finally, we performed circadian analysis of time-stamped heart rate (HR) variation from a PH cohort compared to controls.</p><p><strong>Results: </strong>In this pilot study, we recruited 103 patients with PH and 38 bed-partner controls (BPCs) aged 20 to 86 years. Compared to BPCs patients with PH had longer sleep duration and less social jet lag (SJL), with no clear difference in chronotype. Within the PH cohort, sleep duration was associated with worse functional class, while SJL was associated with a low risk for disease progression, and more severe signs of right ventricular dysfunction. However, a later chronotype was associated with a decrease in mean pulmonary artery pressure (mPAP). In an independent cohort of PH patients there was a relationship between functionally distinct core clock gene SNP variants and relevant hemodynamic parameters. PH patients exhibited a distinct delayed phase shift in circadian HR variation.</p><p><strong>Interpretation: </strong>PH in adults is associated with significant changes in sleep duration and SJL, corroborated by both genomic and physiologic data. Dependence between circadian variables, SNP data and disease characteristics suggests that findings may directly relate to disease pathogenesis via derangement in the molecular core clock.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034363","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":"Nocturnal Oxygen Therapy for Central Sleep Apnea in Patients with Heart Failure: A Multi-site, Double-blind, Sham-controlled Randomized Clinical Trial (LOFT-HF).","authors":"Susan Redline, Dongdong Li, Shahrokh Javaheri, Sanjay R Patel, Sairam Parthasarathy, James C Fang, Lee K Brown, Mark Dunlap, M Safwan Badr, Neomi Shah, Luqi Chi, Ruckshanda Majid, Mihaela Teodorescu, Garrick Stewart, Eileen Hsich, Tamar Polonsky, Justin Vader, Maryl R Johnson, Dennis Auckley, Henry Klar Yaggi, Andrew Kao, Ali Azarbarzin, Raichel Alex, Michael Rueschman, Lisa Wolfe, Daniel J Gottlieb, Scott A Sands, Phyllis C Zee, Reena Mehra, Babak Mokhlesi, Rami Khayat, Eldrin F Lewis, William T Abraham, Rui Wang","doi":"10.1513/AnnalsATS.202504-409OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202504-409OC","url":null,"abstract":"<p><strong>Rationale: </strong>There are insufficient data to inform the management of central sleep apnea (CSA) in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nocturnal oxygen therapy (NOT) has been postulated to benefit CSA patients with HFrEF, but has not been rigorously studied. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p><p><strong>Objectives: </strong>To compare NOT to sham-NOT (control) in HF patients receiving guideline-based heart failure therapy on the composite outcome of first occurrence of either mortality due to any cause, a life-saving cardiovascular intervention, or unplanned hospitalization for worsening heart failure, along with other secondary outcomes.</p><p><strong>Methods: </strong>A multi-site, double-blind, sham-controlled randomized clinical trial was conducted from Sept 2019 to Dec 2021, when the study was terminated prematurely due to slow enrollment. Cox proportional hazards regression models were used to analyze time-to-event outcomes.</p><p><strong>Measurements and main results: </strong>Ninety-eight participants (mean left ventricular ejection fraction: 27.8 ± 9.6%; central apnea hypopnea index: 30.6 ± 18.2 events/hr) were randomized and followed for an average of 10.8±6.3 months. A total of 22 events met the criteria for the primary composite endpoint. The hazard ratio (95% Confidence Interval [CI]) comparing the NOT group to the control group based on the time-to-first event, adjusted for the stratification factor (hospitalization for heart failure in the last 12 months and/or elevated outpatient brain natriuretic peptide (BNP) or NTproBNP level) was 1.46 (95% CI: 0.65, 3.29). No group difference in changes in patient-reported outcomes (heart-failure specific quality of life [Kansas City Cardiomyopathy Questionnaire], sleep disturbance and sleep related-impairment [Patient-Reported Outcomes Measurement Information System], generic health [EuroQol 5D]; or mood [Patient Health Questionnaire-8]) was observed at 6 months. Polysomnography showed improved indices of sleep-disordered breathing (apnea hypopnea index, central apnea hypopnea index, and time at oxygen saturation below 90%) with oxygen compared to room air.</p><p><strong>Conclusions: </strong>While NOT improves CSA and overnight oxygenation, this prematurely terminated study does not provide support for the clinical effectiveness of NOT in patients with CSA and HFrEF. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034482","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":"Health Inequity in People with Cystic Fibrosis: Can We Close the Gap?","authors":"Isabelle Sermet-Gaudelus, Annalisa Orenti, Elpis Hatziagorou, Egil Bakkeheim, Lutz Naehrlich, Eitan Kerem","doi":"10.1513/AnnalsATS.202501-052OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-052OC","url":null,"abstract":"<p><p>Background Although advances in care have improved cystic fibrosis (CF) outcomes in higher-income countries (HICs), the situation remains alarming in lower-income countries (LICs). Methods People with CF (pwCF) enrolled in the European Cystic Fibrosis Society Patient Registry (ECFSPR) and carrying at least one F508del variant allele were evaluated in 2017 and in 2022 for predicted percent forced expiratory volume (ppFEV1), underweight status, and chronic Pseudomonas aeruginosa (Pa) infection, according to the gross national income (GNI) per capita divided into three terciles (low-income countries, LICs; middle-income countries, MICs; and high-income countries, HICs). Survival was evaluated in the periods 2013-2017 and 2018-2022. Generalized linear models and Cox regression models were fitted. Findings From the 31,723 pwCF reported in ECFSPR in 2022, 13.5% lived in LICs, 19.9% in MICs, and 66.6% in HICs. PwCF living in LICs had a significantly lower median survival age, reduced ppFEV1, and higher prevalence of Pa infection and underweight status compared with pwCF from MICs and HICs. Data modeling indicated that avoiding underweight status and Pa infection would increase survival by 42 years for pwCF living in LICs. Access to CFTR modulators would further increase their survival by 15 to 29 years depending on their nutrition and infection status, resulting in a survival up to 82 years in the best-case scenario. Interpretation Access to CFTR modulators equalizes survival between LICs and higher income countries within Europe. Optimizing care practices and social determinants of health remains crucial in LICs.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034349","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":"Co-morbid Insomnia and Sleep Apnea Is Associated with Uncontrolled Hypertension in a Middle-aged Population.","authors":"Mio Kobayashi Frisk, Joel Bergqvist, Sven Svedmyr, Philippe Diamantis, Göran Bergström, Ding Zou","doi":"10.1513/AnnalsATS.202501-080OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-080OC","url":null,"abstract":"<p><strong>Introduction: </strong>Co-morbid insomnia and sleep apnea (COMISA) has been linked to poorer health outcomes and increased all-cause mortality compared with either insomnia or obstructive sleep apnea (OSA) alone.</p><p><strong>Materials and methods: </strong>We investigated the relationship between COMISA and uncontrolled hypertension in the Swedish CardioPulmonary BioImage Study (SCAPIS). A cross-sectional analysis including participants from the SCAPIS Gothenburg cohort (n=3832, 46% males, age 57.5±4.3 years, body mass index 26.6±4.3 kg/m2) was performed. Subjects underwent a comprehensive examination, including functional tests and a home polygraph sleep recording. COMISA was defined as an apnea-hypopnea index (AHI) >10 events/h and an Insomnia Severity Index score ≥15. Blood pressure (BP) status was characterized as uncontrolled hypertension (office systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg), controlled hypertension (antihypertensive medication-treated hypertension with systolic/diastolic BP < 140/90 mmHg) or normotension with systolic/diastolic BP <140/90 mmHg.</p><p><strong>Results: </strong>The prevalence of COMISA was 3.1% in the population and 14.5% among OSA patients (AHI >10 events/h). AHI was comparable between OSA-only and COMISA patients (18±9 vs. 19±9 events/h, P=0.86). Uncontrolled hypertension was found in 4.4%, 4.5%, 7.9% and 10.2% of the control group, insomnia-only, OSA-only, and COMISA group, respectively (p<0.001). Compared to the control group, the risk of uncontrolled hypertension was significantly increased in the OSA-only group (odds ratio[95%CI]: OR 1.31[1.05 - 1.64], p=0.02) and the COMISA group (OR 1.88[1.23 - 2.89, p=0.004) after controlling for anthropometrics, lifestyle, comorbidities, Epworth sleepiness scale and nocturnal hypoxic exposure (T90, % recording time with oxygen saturation ≤ 90%). T90 was found to be a significant mediator in the relationship between both OSA and COMISA to uncontrolled hypertension.</p><p><strong>Conclusions: </strong>This study is the first to demonstrate an independent association between COMISA and uncontrolled hypertension in the general population. These findings provide novel insights for identifying subgroups of OSA patients at risk of adverse cardiovascular consequences. Furthermore, our results underscore the importance of recognizing sleep health as a multidimensional construct and advocate for personalized treatment strategies to effectively combat the burden of this common sleep disorder. (See data supplement for graphical abstract and summary of key findings).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024849","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":"Neutrophil-to-Lymphocyte Ratio (NLR) as a Biomarker in Clinically Stable Chronic Obstructive Pulmonary Disease: SPIROMICS cohort.","authors":"Daniel T Hoesterey, Hong Dang, Daniela Markovic, Russell G Buhr, Donald P Tashkin, R Graham Barr, John A Belperio, Russell P Bowler, Eugene R Bleecker, David J Couper, Gerard G Criner, Christopher B Cooper, Claire M Doerschuk, Mark T Dransfield, M Bradley Drummond, Ashraf Fawzy, Christine M Freeman, MeiLan K Han, Nadia N Hansel, Annette T Hastie, Eric A Hoffman, Yvonne J Huang, Robert J Kaner, Richard E Kanner, Victor Kim, Jerry A Krishnan, Fernando J Martinez, Wanda K O'Neal, Victor E Ortega, Robert Paine, Abhishek K Shrivastav, J Michael Wells, Prescott G Woodruff, Jeffrey L Curtis, Igor Barjaktarevic","doi":"10.1513/AnnalsATS.202412-1265OC","DOIUrl":"10.1513/AnnalsATS.202412-1265OC","url":null,"abstract":"<p><strong>Rationale: </strong>Inflammation is central to chronic obstructive pulmonary disease (COPD) pathogenesis but incompletely represented in COPD prognostic models. Neutrophil to lymphocyte ratio (NLR) is a readily available inflammatory biomarker.</p><p><strong>Objectives: </strong>To explore the associations of NLR with smoking status, clinical features of COPD, and future adverse outcomes.</p><p><strong>Methods: </strong>We analyzed NLR calculated from the complete blood count of participants who currently or formerly smoked (n = 2,624) and tobacco-naïve controls (n = 187) in the SPIROMICS multicenter observational cohort study. We assessed the stability of NLR at 6 weeks and 1 year, the association with select blood biomarkers, and the impact of smoking on NLR and cell counts. We stratified participants by NLR quartiles to compare cross-sectional clinical features at enrollment, prospectively observed exacerbations at 1 year, and mortality during longitudinal follow-up.</p><p><strong>Results: </strong>Higher NLR quartiles were broadly associated with more severe clinical features of COPD. NLR values were repeatable at 6 weeks (ICC=0.74) and 1 year (ICC=0.62). The impact of smoking on NLR varied with the severity of airflow limitation, mediated by an interaction between smoking, FEV1 % predicted, and neutrophil counts but not lymphocyte counts. The highest NLR quartile (>3.11) was associated with an increased risk of exacerbation over 1-year (adjusted OR=1.51 95%CI 1.18, 1.92) and increased risk of mortality (adjusted HR=1.41, 95%CI 1.20, 1.66) compared to quartiles 1-3.</p><p><strong>Conclusions: </strong>Elevated NLR in stable COPD is a widely available biomarker associated with increased risk for exacerbation and death. The impact of cigarette smoking on NLR varies with disease severity.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024914","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":"Evaluating Long-Term Effectiveness of Cystic Fibrosis Modulator Therapies After Rapid Adoption: A Dual-Approach Study.","authors":"Pedro Miranda Afonso, Grace C Zhou, Weiji Su, Pierre-Régis Burgel, Elizabeth Cromwell, Christopher H Goss, Ruth H Keogh, Theodore G Liou, Bruce C Marshall, Nicole Mayer-Hamblett, Wayne J Morgan, Joshua S Ostrenga, David J Pasta, Michael S Schechter, Sanja Stanojevic, Claire E Wainwright, Rhonda D Szczesniak, Eleni-Rosalina Andrinopoulou","doi":"10.1513/AnnalsATS.202503-267OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202503-267OC","url":null,"abstract":"<p><strong>Rationale: </strong>Modulator therapies like ivacaftor have revolutionized clinical management of cystic fibrosis (CF), showing marked short-term benefits in trials but heterogeneous findings in long-term observational studies. Since newer modulators have become the standard of care for the majority living with CF in the U.S., characterizing long-term effectiveness with real-world data is increasingly difficult due to the lack of contemporary comparator groups for performing between-subjects analyses.</p><p><strong>Objectives: </strong>To determine the extent to which ivacaftor preserves long-term lung function and compare the results of within- and between-subject analyses for evaluating its real-world effectiveness.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the US Cystic Fibrosis Foundation Patient Registry (2003-2016). We employed two approaches to evaluate ivacaftor effectiveness on percent predicted forced expiratory volume in 1s (ppFEV1): i) within-subject comparisons of ppFEV1 before and after ivacaftor initiation and ii) comparisons between ivacaftor-treated and untreated individuals with similar disease pathology. We modeled data from 560 ivacaftor-treated individuals with the G551D variant. For between-subject comparisons, we used propensity scores to match the treated group with 2,800 untreated F508del homozygous individuals. Modulator initiation bias was assessed and accounted for in each model.</p><p><strong>Results: </strong>Our results showed an initial average improvement in ppFEV1 in ivacaftor-treated children and adults (ranging from 4.54 to 6.53% predicted based on within-subject comparison of before vs. after ivacaftor initiation). There was a slower decline in adults, compared to children. These ivacaftor-treated cohorts experienced less decline relative to their F508del homozygous counterparts (between-group differences in treated vs. control ranged from 0.36 to 0.64% predicted). Both the within- and between-subject comparisons demonstrated similar levels of ivacaftor effectiveness. However, small differences between the two approaches were observed in younger individuals.</p><p><strong>Conclusions: </strong>Ivacaftor was associated with improved ppFEV1 across all age groups, with the magnitude of improvement roughly 50% of that observed in clinical trials. The results support the need to account for modulator initiation bias and the use of within-subject analysis in future CFTR modulator effectiveness studies, but caution is advised in younger individuals due to developmental changes that may affect pre- and post-treatment comparability.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024906","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":"Prognostic Significance of Peripheral Blood Monocyte Count Among a National Cohort of Veterans with Pulmonary Fibrosis.","authors":"Bhavika Kaul, Laura A Petersen, Harold R Collard, Peter Richardson, Ning Zhang, Mary A Whooley, Mallar Bhattacharya","doi":"10.1513/AnnalsATS.202410-1108OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1108OC","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated peripheral blood monocyte counts (PBMC) are associated with disease progression and mortality in patients with idiopathic pulmonary fibrosis (IPF). However, evidence for progression stems primarily from highly curated cohort studies or post-hoc analysis of clinical trials. We used real-world data to examine the association between PBMC and IPF mortality among a national cohort of Veterans with IPF.</p><p><strong>Methods: </strong>We used an ICD-code based electronic health record algorithm to identify Veterans with IPF. Those who had PBMC available within 180 days of index IPF diagnosis were included in the analytical cohort. Mortality analyses were conducted using Cox proportional hazard models.</p><p><strong>Results: </strong>We identified 30,419 Veterans with IPF and a PBMC available for analysis. Veterans with PBMC ≥ 0.95 x 109 cells/L had a 51% higher risk of all-cause mortality (HR 1.51, 95% CI 1.44 - 1.58, p<0.001) in an unadjusted analysis. The risk persisted in models adjusted for age and sex (HR 1.43, 95% CI 1.36 - 1.50, p<0.001) and after adjustment for oxygen utilization as a surrogate marker of disease severity (HR 1.35, 95% CI 1.29 - 1.41, p<0.001). There was a stepwise increase in mortality risk as peripheral blood monocyte counts increased with a monocyte dichotomization threshold between 0.4 and 0.5 x 109 cells/L associated with HR for mortality of greater than 1.0 for both unadjusted and adjusted models.</p><p><strong>Conclusion: </strong>We found that a stepwise increase in PBMC was associated with an increased all-cause IPF mortality. A PBMC dichotomization threshold between 0.4 and 0.5 x 109 cells/L, which is lower than previously reported, was associated with an increased risk of mortality.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024898","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}