Chest最新文献

{"title":"Days Alive and Out of Hospital Around Lung Transplantation: Predictors and Clinical Implications.","authors":"Antoine El Kik, Pauline Bian, Leïla Pellet, Gilles Chatellier, Kinan El Husseini, Laurence Beaumont, Benjamin Renaud-Picard, Martine Reynaud-Gaubert, Claire Merveilleux du Vignaux, Xavier Demant, Thomas Villeneuve, Adrien Tissot, Loïc Falque, Nicolas Carlier, Charlotte Roy, Olaf Mercier, Jérôme Le Pavec, Joconde Weller, Pauline Pradère","doi":"10.1016/j.chest.2026.08.042","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.042","url":null,"abstract":"<p><strong>Background: </strong>Days alive and out of hospital (DAOH) is a validated patient-centered outcome that remains unexplored in lung transplantation (LT). It assesses the proportion of days a patient spends alive and outside of hospital. Quantifying DAOH trajectories around LT could provide patients with realistic expectations and better prepare them for the demanding post-transplant period.</p><p><strong>Materials and methods: </strong>DAOH was calculated for the year before (DAOH-BF) and two years after first LT (DAOH-AF1, DAOH-AF2) for all patients transplanted in France between 2020 and 2023. Clinical variables were collected to identify predictors of DAOH-AF1 using a two-part model.</p><p><strong>Results: </strong>1,222 patients were included (56% male; median age 57, IQR 47-62). Median DAOH-BF was 95% (IQR, 89-99%), whereas median DAOH-AF1 declined to 80% (IQR, 64-87%, p < 0.001). Among patients discharged after the transplantation-related hospital stay, connective tissue disease (β = -4.1, p = 0.05) and single-LT (β = -4.0, p = 0.040) were independently associated with lower DAOH-AF1. Median DAOH-AF2 subsequently recovered to 98.6% (IQR, 95.1-100%).</p><p><strong>Conclusion: </strong>DAOH is significantly reduced during the first post-LT year, particularly among patients with connective tissue disease and in case of single LT. These findings have direct implications for pre-LT counselling, informing patients about the demanding nature of the first year post-LT while offering reassurance that DAOH improves substantially beyond this period. Identified predictors of lower DAOH-AF1 allow clinicians to further tailor pre-LT information to high-risk subgroups.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890848","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":"Impairment of upper airway patency and CPAP effectiveness during obstructive sleep apnea treatment with expiratory pressure alleviation: a randomized study.","authors":"Gustavo Freitas Grad, Ivana Rosanelli, Mariana Delgado Fernandes, Aline Brunacci Monare, Marcela Yanagimori, Iris Fragoso da Silva Cruz, Paulo Mateus Madureira Soares Mariano, Geraldo Lorenzi-Filho, Pedro Rodrigues Genta","doi":"10.1016/j.chest.2026.08.041","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.041","url":null,"abstract":"<p><strong>Background: </strong>Expiratory pressure alleviation (EPA) algorithms have been incorporated into CPAP devices to reduce expiratory discomfort during treatment of obstructive sleep apnea (OSA). Since pharyngeal narrowing or collapse can occur during expiration, EPA may impair upper airway patency.</p><p><strong>Research question: </strong>Does EPA compromise upper airway patency and CPAP efficacy in patients with severe OSA?</p><p><strong>Study design and methods: </strong>Adults with severe OSA using nasal CPAP were considered to participate. The study was conducted in four steps. Steps 1 and 2 were performed during a single overnight polysomnography (PSG) study. In step 1, peak inspiratory flow (PIF) was measured during inspiratory flow limitation with and without EPA. In step 2, CPAP titration was performed in randomized order with and without EPA. Steps 3 and 4 were conducted at home. Residual AHI and adherence were compared with and without EPA activation during fixed (Step 3) and auto-CPAP (Step 4).</p><p><strong>Results: </strong>Twenty-nine subjects were studied (55% female; age 63±12 years; BMI 37±7 kg/m²; AHI 58 (39-83) events/h). EPA activation reduced PIF compared to without EPA (0.38 (0.34-0.42) vs 0.19 (0.15-0.23) L/s), respectively (P<0.001). Manually titrated CPAP level was higher with EPA than without EPA (11.40 ± 1.95 vs 9.17 ± 1.78 cmH₂O), respectively (P<0.001). Residual AHI was higher with EPA than without EPA, during fixed (3.7 ± 2.2 vs 1.3 ± 0.6 events/h) and automatic CPAP (1.4 (0.6 - 2.1) vs (0.8 (0.5-1.8) events/h), respectively (P<0.05). No significant change in CPAP adherence was observed, during fixed (7.0 ± 0.8 vs 7.2 ± 1.0 hours) and automatic CPAP (7.0 ± 1.3 vs 6.9 ± 1.3 hours), with (P=0.497) and without (P=0.506) EPA, respectively.</p><p><strong>Interpretation: </strong>EPA application compromised upper airway patency and required higher therapeutic CPAP than without EPA. EPA also impaired OSA control but did not impact CPAP adherence.</p><p><strong>Clinical trials registry: </strong>NCT05219591.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886321","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":"Making Palliative Care Work in Chronic Respiratory Diseases: A Nurse-Led Model.","authors":"Ivan Guerreiro, Caroline Matis, Tanja Fusi-Schmidhauser, Samia Lounnas, Filipa Alexandra Baptista Peixoto Befecadu, Gregory Berra, Anne Bergeron, Sophie Pautex, Lisa Hentsch","doi":"10.1016/j.chest.2026.08.040","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.040","url":null,"abstract":"<p><p>Palliative care (PC) is defined as a holistic, multidisciplinary, person-centered approach aimed at relieving symptoms and improving quality of life (QoL) for individuals with serious health-related disease. Although recommended by major respiratory societies, patients with advanced chronic respiratory diseases (CRD) continue to have insufficient access to PC, often limited to end-of-life (EoL) care. Compared with patients with lung cancer, patients with CRD experience greater symptom burden, are less informed about their illness, and are less involved in decision-making. Early PC has been shown to improve QoL, reduce depression, decrease avoidable hospitalizations, and support better EoL trajectories. To improve PC providing for patients living with CRD, an interdisciplinary, nurse-led, outpatient PC consultation model was developed and iteratively refined guided by the Plan-Do-Study-Act cycle, as an implementation framework. Patients are referred to the consultation based on symptom burden, decline in respiratory status, frailty, need for discussion on treatment choice, or caregiver strain. During the initial consultation, a PC physician and nurse explore patient and caregiver perceptions of PC, provide information about the aim of this service, and conduct a comprehensive symptom assessment. Follow-up is primarily coordinated by the specialist PC nurse, who ensures symptom evaluation, care coordination, and knowledge on pharmacological and non-pharmacological interventions. Integrative therapies such as hypnosis, reflexology, and Touch-Massage® are also offered, along with discussions around advance care planning when desired. Early, needs-based PC can be effectively integrated into CRD trajectories when delivered through a nurse-led interdisciplinary model of coordination.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886442","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":"Tobacco Treatment in the Inpatient Setting: An American College of Chest Physicians Clinical Practice Guideline.","authors":"H Kathuria, I Soghier, A C Alexander, J T Fathi, L M Fucito, J M Iaccarino, F T Leone, J Lin, J S Ostroff, K P Richter, N A Rigotti, A M Rojewski, P Selby, B A Toll","doi":"10.1016/j.chest.2026.08.038","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.038","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking remains the leading cause of preventable death in the United States, with high prevalence among hospitalized patients. Hospitalization presents an opportunity to initiate and engage patients in tobacco treatment, yet guidance for tobacco treatment in this setting has been limited. This clinical practice guideline provides evidence-based recommendations for tobacco treatment in the inpatient setting.</p><p><strong>Study design and methods: </strong>A multidisciplinary panel followed CHEST's standardized clinical practice guideline methodology, including systematic literature searches in MEDLINE, Embase, and the Cochrane Database. Key clinical questions were framed using the PICO format. Eligible studies included randomized controlled trials and cohort studies. Evidence was appraised using GRADE, and recommendations were formulated through a modified Delphi process to achieve consensus.</p><p><strong>Results: </strong>We identified 9330 abstracts, assessed 252 full texts, and included 142 studies. The literature review and analysis, based on 6 PICO questions, yielded 8 recommendations. No recommendations were supported by high-certainty evidence specific to inpatient tobacco treatment settings. Of the eight recommendations, four were supported by moderate-certainty evidence, two by low-certainty evidence, and two by very low-certainty evidence, supplemented by expert consensus.</p><p><strong>Interpretation: </strong>Hospitalization offers a critical window to initiate tobacco treatment. This guideline synthesizes the existing literature to inform key components of inpatient tobacco treatment, including an opt-out population-based approach that proactively provides counseling and pharmacotherapy to all patients who smoke unless they explicitly decline; the initiation and selection of pharmacotherapies during hospitalization; counseling approaches delivered during the inpatient stay; and post-discharge counseling approaches following hospital discharge. Implementing these approaches is likely to improve smoking-cessation outcomes and reduce hospital readmissions and costs. The guideline also evaluates the strength and limitations of the current evidence base and identifies priority areas for future research, including identifying optimal implementation strategies, equity considerations, and the evaluation of cost-effectiveness across diverse hospital settings and patient populations.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879383","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":"The airway microbiome in asthma.","authors":"Hollian Richardson, Jennifer Pollock, Rory Chan, James D Chalmers","doi":"10.1016/j.chest.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.032","url":null,"abstract":"<p><strong>Topic importance: </strong>Asthma is a heterogenous airways disease characterized by variable airflow limitation, airway inflammation and bronchial hyperresponsiveness. There is evidence to suggest that the airway microbiome plays an important role in asthma pathophysiology. Most microbiome studies have investigated the bacterial constituents of the microbiome and further studies are needed to investigate the role of the airway virome and mycobiome in asthma.</p><p><strong>Review findings: </strong>Airway microbiome dysbiosis is associated with asthma development, disease severity and inflammatory endotypes. However, it remains unclear whether dysbiosis drives inflammation or is a result of inflammation. Haemophilus and Moraxella alongside rhinovirus and respiratory syncytial virus have been shown to be associated with the development of asthma in children. In established asthma, airway microbiome dysbiosis is associated with severity and risk of exacerbation. Distinct airway microbiome profiles are observed for the different inflammatory endotypes. Asthmatic patients with eosinophilic inflammation have higher microbial diversity similar to healthy individuals while neutrophilic inflammation is associated with reduced microbial diversity, higher bacterial load and a pathogen-dominated microbiome profile suggesting an important role for dysbiosis in asthma that is currently refractory to anti-T2 biologic therapy.</p><p><strong>Summary: </strong>To understand the role of the microbiome in asthma, microbiome data must be integrated with other 'omic approaches' such as proteomics. Recent studies have used a multi-omic approach to investigate the microbiome and host interaction as well as identifying asthma endotypes and potential therapeutic targets. Antibiotics, probiotics, monoclonal antibodies, and diet could theoretically be used to therapeutically target the airway and gut microbiome in asthma.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863585","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":"Multicenter invasive validation of the Venous Excess Ultrasound Score (VExUS) in patients referred for pulmonary hypertension.","authors":"Michele D'Alto, Nicola Cangiano, Antonio Orlando, Paola Argiento, Roberto Badagliacca, Eduardo Bossone, Silvia Caiazza, Matteo Cameli, Gaetano Maria De Ferrari, Andrea Guarnaccia, Stefano Ghio, Walter Grosso Marra, Silvia Papa, Claudia Raineri, Gaetano Rea, Francesca Renon, Emanuele Romeo, Laura Scelsi, Carmine Dario Vizza, Robert Naeije","doi":"10.1016/j.chest.2026.08.031","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.031","url":null,"abstract":"<p><strong>Background: </strong>The Venous Excess Ultrasound (VExUS) score is increasingly used to assess systemic venous congestion, yet direct validation against invasively measured right atrial pressure (RAP) in pulmonary hypertension (PH) remains limited.</p><p><strong>Research question: </strong>How accurate is the VExUS score to predict RAP in patients with established or suspected PH?</p><p><strong>Methods: </strong>We conducted a multicenter observational study across 7 Italian reference centers including patients referred for PH and undergoing a VExUS assessment and right heart catheterization within 1 hour. A VExUS score was calculated with a 0 to 3 grading based on inferior vena cava (IVC) diameter and collapsibility, and Doppler assessment of hepatic, portal, and intrarenal venous flow patterns. The diagnostic performance of VExUS for identifying elevated RAP thresholds was compared with echocardiographic estimates based on IVC diameter and inspiratory collapse and RA surface areas using a multivariable analysis followed by receiver operator curves (ROC) calculations. Subgroup analyses were performed across pulmonary hemodynamic phenotypes (normal hemodynamics vs pre- vs postcapillary PH).</p><p><strong>Results: </strong>The study included 145 patients with pre-capillary PH, most of whom with pulmonary arterial hypertension (PAH), 21 with post-capillary PH, and 21 with no PH. The VExUS score showed a strong graded association with RAP, with mean RAP increasing across VExUS grades (0: 3.9 mmHg; 1: 8.4 mmHg; 2: 13.5 mmHg; 3: 15.8 mmHg; p<0.001). The VExUS score demonstrated excellent discrimination for elevated RAP >12 mmHg (AUC 0.97, 95% CI 0.94-0.99), with higher diagnostic performance than isolated echocardiographic markers and performance comparable to echocardiographic RAP estimation. These findings were consistent across hemodynamic phenotypes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857063","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":"The impact of national health systems on lung cancer mortality.","authors":"Nipun Gorantla, Edward Christopher Dee, Jonas Willmann, Erin Jay G Feliciano, James Fan Wu, Christian Daniel U Ang, Fabio Ynoe Moraes, Daniel R Gomez, Corinne Faivre-Finn, Nancy Y Lee, Matthias Guckenberger, Puneeth Iyengar","doi":"10.1016/j.chest.2026.08.021","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.021","url":null,"abstract":"<p><p>Cancers of the trachea, bronchus, and lung represent the leading cause of cancer death globally; therefore, understanding the levers that are associated with outcomes of patients with lung cancer may inform health system planning and investment. We used global health system data from the World Health Organization (WHO), the World Bank, the Directory of Radiotherapy Centres (DIRAC), the United Nations Development Programme (UNDP), and the International Agency for Research on Cancer (IARC) to evaluate predictors of improved global outcomes for cancers of the trachea, bronchus, and lung. In a multivariable model, health spending, nurse/midwife density, universal health coverage index, and radiotherapy center density were independently associated with lower mortality-to-incidence ratio for cancers of the trachea, bronchus, and lung, whereas physician density had a small positive adjusted association. These findings may be of particular utility for countries facing a high or increasing burden of lung cancer.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857003","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":"Efficacy and safety of gabapentin for treatment of cough in idiopathic pulmonary fibrosis: a randomized, double-blinded, placebo-controlled clinical trial.","authors":"Yaxing Zhou, Xu Ju, Yuan Zhang, Shengyuan Wang, Tongyangzi Zhang, Ronglin Gao, Ya Li, Xuan Wang, Li Yu, Xianghuai Xu","doi":"10.1016/j.chest.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.030","url":null,"abstract":"<p><strong>Background: </strong>Cough is common in idiopathic pulmonary fibrosis (IPF) and substantially impairs quality of life, but effective treatment options are limited. Gabapentin reduces cough in refractory chronic cough, but its efficacy and safety in IPF-related cough are uncertain.</p><p><strong>Research question: </strong>Does gabapentin improve cough in patients with IPF?</p><p><strong>Study design and methods: </strong>This study was a randomized, double-blind, placebo-controlled clinical trial conducted at Tongji Hospital, Tongji University. Patients diagnosed with IPF according to the ATS/ERS/JRS/ALAT guidelines, with chronic cough lasting for more than 8 weeks and a cough visual analog scale (VAS) score ≥40 mm, were included. Participants were randomly assigned in a 1:1 ratio to receive either gabapentin or placebo. Gabapentin was titrated to a maximum of 900 mg/d during 12 weeks of treatment, followed by a 4-week post-treatment follow-up. The primary endpoint was the cough relief rate at T4 (end of treatment), defined as the proportion of participants achieving a reduction of at least 50% in total Cough Symptom Score (CSS) from baseline. Safety was assessed in all participants who received at least one dose of study treatment.</p><p><strong>Results: </strong>Between May 1, 2021, and December 31, 2024, 72 participants were screened, of whom 68 were randomized to gabapentin or placebo. Five participants withdrew prior to study completion. At T4, the cough relief rate was higher with gabapentin than with placebo (73.5% vs 26.5%), with a placebo-adjusted absolute difference of 47.1 percentage points (95% CI, 26.1-68.0; P < 0.001). During treatment, adverse events occurred in 32.4% of participants receiving gabapentin and 8.8% receiving placebo. The most common adverse events in the gabapentin group were drowsiness, fatigue, and dizziness.</p><p><strong>Interpretation: </strong>Gabapentin demonstrated significant efficacy with an acceptable safety profile in treating cough in IPF. These findings support gabapentin as a potential treatment option for IPF-related cough.</p><p><strong>Clinical trial registration: </strong>The study was registered with the Chinese Clinical Trial Registry (ChiCTR2100045202).</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856873","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":"Septic shock after allogeneic hematopoietic stem-cell transplantation: outcomes and prognostic factors in a multicenter ICU cohort.","authors":"Marielle Subileau, Dara Chean, Thibault Dupont, Emmanuel Canet, Anne-Sophie Moreau, Muriel Picard, Djamel Mokart, Laura Platon, Julien Mayaux, Florent Wallet, Nahema Issa, Jean-Herlé Raphalen, Frédéric Pène, Anne Renault, Delphine Arnales, Caroline Van De Wyngaert, Hélène Kemp, Aliénor Xhaard, Naike Bigé, Michaël Darmon, Elie Azoulay, Antoine Lafarge","doi":"10.1016/j.chest.2026.06.075","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.075","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a major cause of intensive care unit (ICU) admission among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, yet data on its epidemiology and prognosis remain limited.</p><p><strong>Research question: </strong>We aimed to describe outcomes, identify independent prognostic factors, and explore associations that may inform early management.</p><p><strong>Study design and methods: </strong>We performed a multicenter retrospective cohort study including allo-HSCT recipients admitted to the ICU with septic shock between 2015 and 2020.</p><p><strong>Results: </strong>Among 1,164 allo-HSCT recipients hospitalized in ICU, 38% (n=444) were admitted for septic shock. The median SOFA score was 8 (IQR, 6-11). Microbiological documentation was obtained in 62% (n=261), including fungal pathogens in 17% (n=74). The respiratory tract was the most common infection source (43%, n=180). Invasive mechanical ventilation and renal replacement therapy were required in 64% (n=284) and 32% (n=143), respectively. Mortality at 90 days and 3 years was 63% (n=280) and 81% (n=350). In the extended Cox model, fungal documentation (HR 1.78 [95% CI, 1.19-2.67], p=0.005), SOFA score (HR 1.07 [95% CI, 1.02-1.13], p=0.007), and neutropenia (HR 3.94 [95% CI, 1.18-13.1], p=0.026) were independently associated with 90-day survival. In a 48-hour landmark analysis, early aminoglycoside use was associated with higher 90-day survival (HR 0.46 [95% CI, 0.33-0.64], p<0.001). However, time-varying analyses indicated a non-constant association over time. Age ≥ 56 years (HR 1.36, [95% CI, 0.99-1.87]), GvHD type, and early bacterial documentation (HR 0.90, [95% CI, 0.64-1.26]) were not associated with 90-day survival.</p><p><strong>Interpretation: </strong>Septic shock after allo-HSCT carries a high mortality (63% at 90 days), largely driven by host-related factors and initial illness severity. The association between aminoglycoside use and outcome is complex, does not support a straightforward causal interpretation, and warrants further prospective evaluation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850002","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":"Predictive Power of Pulmonary Artery Stiffness - Right Ventricular Interplay, but not Pulmonary Vascular Resistance, in Mild Pulmonary Hypertension: A PVRI GoDeep meta-registry analysis.","authors":"Athiththan Yogeswaran, Meike Fünderich, David G Kiely, Jeffrey S Annis, Evan Brittain, Harm Jan Bogaard, Aparna Balasubramanian, Paul M Hassoun, Luke Howard, Allan Lawrie, Martin R Wilkins, Thenappan Thenappan, Jean Elwing, Arun Jose, Mona Lichtblau, Silvia Ulrich, Lars Harbaum, Hans Klose, Andrew J Sweatt, Roham T Zamanian, Edmund M Lau, Keiichiro Kuronuma, Hiromi Matsubara, Nathan Dwyer, Yuriy Sirenko, Olena Torbas, Christina A Eichstaedt, Ekkehard Grünig, Melanie Lavender, Alexandra Arvanitaki, George Giannakoulas, Marlize Frauendorf, Paul G Williams, Zhenguo Zhai, Zhu Zhang, Anastasia Anthi, Effrosyni Dima, Hani Sabbour, Khaled Saleh, Stefano Ghio, Laura Scelsi, Juliana De Luque Figueroa, Mauricio Orozco-Levi, Alba Ramirez-Sarmiento, Siva Sivakumaran, James Anderson, Stephen Y Chan, Ingrid King, Horst Olschewski, Hossein-Ardeschir Ghofrani, Friedrich Grimminger, Raphael W Majeed, Jochen Wilhelm, Khodr Tello, Werner Seeger","doi":"10.1016/j.chest.2026.07.5243","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5243","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vascular diseases are characterized by mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), both reflecting the steady-flow component of right ventricular (RV) afterload while neglecting pulsatile elements. Pulmonary artery compliance (PAC) and arterial elastance (E_a) capture complementary aspects of pulmonary vascular load, whereas stroke volume index (SVI) reflects RV functional adaptation. The prognostic significance of these integrated parameters remains incompletely understood, particularly in early-stage disease.</p><p><strong>Research question: </strong>Do PAC, E_a, and SVI predict mortality independently of PVR in patients with mild PH and across the full spectrum of pulmonary hypertension (PH)?</p><p><strong>Methods: </strong>Using the international PVRI GoDeep meta-registry, we first evaluated the prognostic relevance of PAC, E_a, and SVI in patients with mild PH, defined as a mPAP >20 and <25 mmHg. Subsequently, these analyses were extended to the overall PH population across the full spectrum of disease severity. Subgroup analyses were performed according to PH etiology. PAC was calculated as the ratio of SV to pulmonary arterial pulse pressure, and E_a as end-systolic pressure divided by SV.</p><p><strong>Results: </strong>In patients with mild PH (n = 1,097), neither mPAP nor PVR predicted mortality (both p>0.05). In contrast, E_a, PAC, SVI, and heart rate demonstrated independent prognostic value. Expanding the analysis to 16,899 patients across PH groups 1-5, these parameters remained significantly associated with survival, independent of PVR/TPR and after adjustment for multiple potential confounders. Consistent findings were observed across etiological subgroups and IPAH/hPAH.</p><p><strong>Interpretation: </strong>Parameters integrating pulsatile vascular load and interdependent RV function possess predictive power independent of PVR/TPR across the full spectrum of PH. Moreover, they allow meaningful risk stratification in mild PH patients, where conventional parameters lack discriminative prognostic power.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825858","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}