Chest最新文献

{"title":"Pleural fluid analysis: Maximizing diagnostic yield in the pleural effusion evaluation.","authors":"Amit Chopra, Kurt Hu, David Feller-Kopman, Marc A Judson","doi":"10.1016/j.chest.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.chest.2025.06.001","url":null,"abstract":"<p><p>Establishing the cause of a pleural effusion can be challenging. Analysis of pleural fluid is a powerful tool to determine the etiology of a pleural effusion. Surprisingly, despite the diagnostic power pleural fluid analysis (PFA), it is often underused. The purpose of this review is to provide a practical framework to maximize the diagnostic potential of the PFA. In this manuscript we will describe the role of a PFA in establishing the cause of a pleural effusion. We will also discuss challenges and limitations of PFA.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309616","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":"Alcohol Use and COVID-19 Outcomes.","authors":"Aaron P Turner, Scott V Adams, Eric Hawkins, Vincent S Fan, Reyhaneh Nikzad, John R Kundzins, Kristina Crothers","doi":"10.1016/j.chest.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.chest.2025.05.039","url":null,"abstract":"<p><strong>Background: </strong>There is increasing recognition that health behaviors may contribute to outcomes following COVID-19, but information on the role of alcohol use is limited.</p><p><strong>Research question: </strong>Are different severity levels of pre-existing alcohol use disorder (AUD), alcohol consumption, and their combination associated with 30-day COVID-19 outcomes?</p><p><strong>Study design and methods: </strong>Utilizing data from a US national cohort (Veterans Administration), we determined the risk associated with AUD, based on diagnostic codes including alcohol abuse, alcohol dependence, and alcohol-related disease (ARD) for COVID-19-related outcomes: mild (outpatient management), moderate (hospitalization), critical (hospitalization with indicators of critical illness), or death. We determined the modification of this risk for different levels of self-reported alcohol consumption using categories defined by an alcohol-use screening tool (Alcohol Use Disorders Identification Test Consumption Questions: AUDIT-C).</p><p><strong>Results: </strong>Out of a total of 463,246 COVID-19+ veterans, those with every severity of AUD (abuse, dependence, ARD) had a lower probability of a mild outcome (adjusted risk ratio (aRR) range=0.75 - 0.98) and greater probability of hospitalization (range aRR=1.14-2.50) compared to Veterans with no AUD for every level of alcohol consumption. This lower likelihood of a mild outcome and higher likelihood of hospitalization increased with the severity of AUD. Veterans with alcohol dependence had increased probability for critical outcome, but only for high consumption (aRR=1.28). Veterans with ARD had a higher probability of a critical outcome and death within every level of consumption (ranges aRR=1.32-2.01 and aRR=1.58-1.91 respectively) with the highest probability seen at high-risk consumption levels.</p><p><strong>Interpretation: </strong>Overall, alcohol use disorders were associated with poorer COVID-19 outcomes. The likelihood of negative outcome generally increased with increasing severity of AUD. The association between the risk of AUD and negative outcome was modified by alcohol consumption, with the poorest outcomes seen with both AUD and high-risk drinking.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282645","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":"Anti-Ro52 Seropositive Interstitial Lung Disease is Associated with a Higher Risk for Disease Progression and Mortality.","authors":"Ryosuke Imai, Rene S Bermea, Sophia H Zhao, Sydney B Montesi, Anjali Singh, Bess M Flashner, Andrew J Synn, Julia K Munchel, Mary B Rice, Alyssa Soskis, Barry S Shea, Robert W Hallowell","doi":"10.1016/j.chest.2025.05.036","DOIUrl":"https://doi.org/10.1016/j.chest.2025.05.036","url":null,"abstract":"<p><strong>Background: </strong>Identifying biomarkers is vital for interstitial lung disease (ILD) management and prognostication. While anti-Ro52 antibodies are frequently detected in autoimmune diseases, their significance in ILD remains unclear.</p><p><strong>Research question: </strong>What is the prognostic significance of anti-Ro52 positivity in patients with ILD?</p><p><strong>Study design and methods: </strong>This retrospective cohort study used an ILD registry of patients seen at an academic tertiary hospital's ILD clinic between 2015 and 2024. All patients diagnosed with ILD and tested for anti-Ro52 antibody status were divided into anti-Ro52 positive (Anti-Ro52+) and negative (Anti-Ro52-) groups. The primary outcome was ILD progression or all-cause death. ILD progression was defined as any of the following: hospitalization due to ILD; absolute decline in forced vital capacity percent of predicted value ≥10% from baseline; or lung transplantation. Kaplan-Meier method and Cox proportional hazards regression model were used for survival analysis.</p><p><strong>Results: </strong>Of 1,026 patients tested for the anti-Ro52 antibody (median age: 70 years; 52% male), 154 (15%) were Anti-Ro52+. Underlying ILD subtypes were as follows: interstitial pneumonia with autoimmune features (IPAF) (n = 489, 48%), connective tissue disease-ILD (n = 132, 13%), idiopathic pulmonary fibrosis (n = 103, 10%), hypersensitivity pneumonitis (n = 61, 6%), and other idiopathic ILD (n = 241, 24%). The Anti-Ro52+ group was younger (median age 67 vs. 70 years), was more likely to have CTD (28% vs. 10%) and more frequently had a copositive myositis-specific antibody (29% vs. 16%). After a median follow-up of 25.6 months, anti-Ro52+ subjects had a higher risk of ILD progression or death (hazard ratio 2.10; 95% CI, 1.61-2.73; P<0.001) and had a higher risk of lung transplant or death (hazard ratio 1.61; 95% CI, 1.11-2.35; P=0.014) on multivariable analysis.</p><p><strong>Interpretation: </strong>Anti-Ro52 seropositive ILD is associated with significantly worse progression-free and transplant-free survival and may inform disease prognostication and monitoring.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246661","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 performance of the surrogate informed consent process for critical care research: A multi-modal study of investigators, coordinators, surrogates, and patients.","authors":"Chloe Glaros, Caroline K Tietbohl, Kristen A Torres, Rafaela Avallone Mantelli, D Clark Files, Matthew F Mart, Michael A Matthay, Karen E A Burns, Daniel D Matlock, Matthew Wynia, Marc Moss","doi":"10.1016/j.chest.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.chest.2025.05.038","url":null,"abstract":"<p><strong>Background: </strong>Surrogates are often required to participate in the informed consent process for critical care research, though how to best engage surrogates in this process remains unclear.</p><p><strong>Research question: </strong>What are the best practices for conducting the surrogate informed consent processes for critical care research?</p><p><strong>Study design and methods: </strong>This study was performed across academic medical centers located in the United States. We conducted a mixed-methods study including quantitative surveys with open-ended questions, focus groups, and semi-structured interviews with principal investigators (PIs), research coordinators (RCs), surrogate decision makers (SDMs) who were approached about a critical care research clinical trial, and when possible, the patient who had been critically ill. Both quantitative and qualitative thematic methods were used in the analysis.</p><p><strong>Results: </strong>In total, 230 individuals (105 RC, 90 PI, 27 surrogates, 8 patients) completed surveys, and 61 participated in focus groups/interviews. In both surveys and focus groups/interviews, participants across all groups believed that RCs (as opposed to PIs) should conduct the consent process, as RCs are not considered to be authority figures and have fewer perceived conflicts of interest. Surrogates appreciated it when research staff waited until an optimal time to initiate contact and were given physical space and a defined period to consider their decision. When compared to PI/RCs, SDMs and/or patients (in surveys) expressed appreciation for research team updates on the patient's condition and were more enthusiastic that a perceived advantage of research was it could help with adherence to clinical protocols (p<0.0001,p=0.0016). Compared to PI/RCs, SDMs thought the written consent was more important and were less concerned with its length, (p=0.001,p<0.0001). All participants felt that phone/electronic consents were less effective than in-person consent, though these modalities could facilitate the inclusion of SDMs who lived far away.</p><p><strong>Interpretation: </strong>This study identified several strategies that could enhance the surrogate informed consent process for critical care research.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246662","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":"Hospitalization Trends and Risk Factors in Rheumatoid Arthritis Related Interstitial Lung Disease: An Observational Study from Ontario, Canada.","authors":"Lee Fidler, Joseph Munn, Jolene H Fisher, Shane Shapera, Andrea S Gershon","doi":"10.1016/j.chest.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.chest.2025.05.030","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233332","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":"Treatment With Oral or Inhaled Treprostinil in Patients With Pulmonary Arterial Hypertension and Cardiovascular Comorbidities.","authors":"R James White, Karim El-Kersh, Stephan Rosenkranz, Veronica Franco, Carmine Dario Vizza, Roberto Badagliacca, Joanna Pepke-Zaba, Jean Elwing, Rahul G Argula, Shelley Shapiro, Hyoshin Kim, Scott Seaman, Eric Shen, Manisit Das, Meredith Broderick, Vallerie McLaughlin","doi":"10.1016/j.chest.2024.11.027","DOIUrl":"10.1016/j.chest.2024.11.027","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of patients with pulmonary arterial hypertension (PAH) have cardiovascular comorbidities. However, the effects of comorbidities on responses to PAH treatment are not well understood.</p><p><strong>Research question: </strong>Do cardiovascular comorbidities in patients with PAH influence the efficacy and tolerability of inhaled or oral treprostinil?</p><p><strong>Study design and methods: </strong>All patients from phase 3 studies Clinical Investigation Into Inhaled Treprostinil Sodium in Patients With Severe Pulmonary Arterial Hypertension (TRIUMPH) (N = 235) and Phase III Clinical Worsening Study of UT-15C in Subjects With PAH Receiving Background Oral Monotherapy (FREEDOM-EV) (N  =  690) were included in this post hoc analysis and were classified as having 0, ≥ 1, or ≥ 2 cardiovascular comorbidities of interest based on patient medical history. The mean difference in 6-minute walk distance and N-terminal pro-brain natriuretic peptide from baseline to week 12 was assessed for TRIUMPH, and the risk and incidence of clinical worsening was assessed for patients in FREEDOM-EV. Adverse events were summarized for each comorbidity grouping for TRIUMPH and FREEDOM-EV.</p><p><strong>Results: </strong>In TRIUMPH, there were 79, 156, and 88 patients with 0, ≥ 1, and ≥ 2 comorbidities, respectively. Patients on inhaled treprostinil had improvements in 6-minute walk distance, with numerically similar improvements for comorbidity subgroups (0: 26 m, P = .020; ≥ 1: 22 m, P = .006; ≥ 2: 21.6 m, P = .043). Significant reductions in N-terminal pro-brain natriuretic peptide were also seen in all subgroups. In FREEDOM-EV, there were 375, 315, and 166 patients with 0, ≥ 1, and ≥ 2 comorbidities, respectively. Regardless of comorbidities, patients on oral treprostinil had a significantly reduced risk of clinical worsening compared with placebo (0: 36% reduction, P = .034; ≥ 1: 41% reduction, P = .014; ≥ 2: 45% reduction, P = .026). In TRIUMPH and FREEDOM-EV, adverse event profiles were typical for this class of medication regardless of the number of comorbidities. A sensitivity analysis using a subset of comorbidities confirmed the findings of our primary analysis.</p><p><strong>Interpretation: </strong>This post hoc analysis suggests that patients with PAH and cardiovascular comorbidities can benefit from combination therapy with inhaled or oral treprostinil.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1746-1758"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766633","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":"Association of Lung Function With Visceral Adiposity and Skeletal Muscle Mass Considering Myosteatosis.","authors":"Young Ju Jung, Min Jung Lee, Eun Hee Kim, Sung-Jin Bae, Hong-Kyu Kim","doi":"10.1016/j.chest.2024.12.018","DOIUrl":"10.1016/j.chest.2024.12.018","url":null,"abstract":"<p><strong>Background: </strong>Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function.</p><p><strong>Research question: </strong>What is the relationship between lung function, visceral adiposity, and skeletal muscle mass, considering myosteatosis measured using CT scans in middle-aged Korean adults?</p><p><strong>Study design and methods: </strong>We reviewed 15,827 participants (9,237 men and 6,590 women) with a mean (SD) age of 52.5 (8.3) years who underwent comprehensive health examinations, including abdominal CT imaging and spirometry. Selected CT scans were segmented automatically to quantify total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area. Muscle quality was assessed by categorizing TAMA into 3 regions based on CT scan density: good-quality muscle (normal attenuation muscle area [NAMA]), fatty muscle (low attenuation muscle area), and intermuscular and intramuscular fat areas. Low lung function was defined as FVC % predicted and FEV₁ < 80% predicted. Standardized residuals for CT scan-derived measurements, adjusted for age and BMI using linear regression, were calculated and stratified into quartiles for lung function comparison. Multivariate logistic regression was used to analyze associations between low lung function and variables.</p><p><strong>Results: </strong>NAMA was positively correlated with FVC and FEV₁, whereas VFA was negatively correlated with both. In men, low FVC and FEV₁ were significantly associated with lower NAMA and higher VFA. Among women with obesity (BMI ≥ 25 kg/m²), low FVC and FEV₁ were associated significantly with higher VFA and lower NAMA (FVC only); among women without obesity, low FVC and FEV₁ were negatively associated with NAMA.</p><p><strong>Interpretation: </strong>Lung function was significantly associated with visceral adiposity and skeletal muscle quality, which differed according to sex and BMI. Improving lung function may require tailored management, including reducing visceral fat, enhancing skeletal muscle quality, or both, based on CT scan-body composition analysis.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1714-1726"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945461","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":"Factors Associated With High Intrathoracic Pressure in Patients With Obesity Undergoing Right Heart Catheterization.","authors":"Gaurav Manek, Shaoxiong Zhang, Eduard Krishtopaytis, Apostolos Perelas, Ghaleb Khirfan, Deborah Paul, David Toth, James E Lane, Robert L Chatburn, Umur Hatipoğlu, Adriano R Tonelli","doi":"10.1016/j.chest.2024.12.034","DOIUrl":"10.1016/j.chest.2024.12.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1759-1763"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977867","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":"Pulmonary Subsolid Nodules: Upfront Surgery or Watchful Waiting?","authors":"Fenglan Li, Linlin Qi, Changfa Xia, Jianing Liu, Jiaqi Chen, Shulei Cui, Liyan Xue, Sainan Cheng, Xu Jiang, Jianwei Wang","doi":"10.1016/j.chest.2024.12.028","DOIUrl":"10.1016/j.chest.2024.12.028","url":null,"abstract":"<p><strong>Background: </strong>Patients with pulmonary subsolid nodules (SSNs) of ≤ 2 cm in diameter and a consolidation to tumor ratio (CTR) of ≤ 0.25 have good postoperative prognoses, but their management remains controversial.</p><p><strong>Research question: </strong>Does upfront surgical intervention lead to higher survival than watchful waiting in patients with SSNs with diameter of ≤ 2 cm and CTR of ≤ 0.25?</p><p><strong>Study design and methods: </strong>Patients with SSNs who underwent thin-section CT scan examination between February 2005 and December 2018 were followed up retrospectively until December 2023 or until all-cause death or lung cancer recurrence or metastases. Patients were divided into observation and surgery groups and categorized further by the diameter and CTR of these SSNs. Event-free survival (EFS) was evaluated using Kaplan-Meier analysis, multivariable-adjusted Cox proportional hazards modeling, propensity score matching, and a noninferiority trial.</p><p><strong>Results: </strong>Data from 1,676 patients were included (surgery group, n = 1,122 [66.9%]; observation group, n = 554 [33.1%]), with a median EFS of 70.2 months (range, 0.3-213.6 months). Comparing the observation group with the surgery group, the 5-year EFS rates in category A (diameter ≤ 2 cm and CTR ≤ 0.25), category A1 (diameter ≤ 1 cm and CTR ≤ 0.25), category A2 (1 cm < diameter ≤ 2 cm and CTR ≤ 0.25), and the combined category (diameter ≤ 3 cm and CTR ≤ 0.5) were 100% vs 99.0%, 100% vs 99.6%, 100% vs 98.6%, and 100% vs 97.4%, respectively. In the above categories of SSNs, the EFS of the observation group was noninferior to that of the surgery group (P < .001 for noninferiority), and the results remained consistent after propensity score matching. Category A2 achieved the maximum hazard ratio of 0.0668, with corresponding 5-year EFS rates for the observation and surgery groups being 100% vs 93.3%, respectively.</p><p><strong>Interpretation: </strong>In patients with SSNs of ≤ 2 cm in diameter and CTR of ≤ 0.25, watchful waiting could be more appropriate than upfront surgical intervention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1764-1777"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 47-Year-Old Woman With Recurrent Fever and Productive Cough.","authors":"Lingjian Wang, Xin Sun, Yuhong Li, Min Peng, Xiaoqing Li, Li Gao, Rui'e Feng, Yunzhi Zhou, Juhong Shi","doi":"10.1016/j.chest.2024.10.053","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.053","url":null,"abstract":"<p><strong>Case presentation: </strong>A 47-year-old woman initially presented with recurrent coughing caused by the ingestion of gritty foods such as nuts over 20 years ago. Subsequently, she experienced frequent postprandial episodes of white sputum containing food particles and suffered from acid reflux and heartburn, which were originally overlooked.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e183-e188"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282647","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}