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Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults. 澳大利亚成年人慢性咳嗽表型的疾病负担、合并症和前因。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-11-11 DOI: 10.1016/j.pulmoe.2023.08.003
S Suresh, J L Perret, E H Walters, M J Abramson, G Bowatte, C Lodge, A Lowe, B Erbas, P Thomas, G S Hamilton, A B Chang, S C Dharmage, D S Bui
{"title":"Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults.","authors":"S Suresh, J L Perret, E H Walters, M J Abramson, G Bowatte, C Lodge, A Lowe, B Erbas, P Thomas, G S Hamilton, A B Chang, S C Dharmage, D S Bui","doi":"10.1016/j.pulmoe.2023.08.003","DOIUrl":"10.1016/j.pulmoe.2023.08.003","url":null,"abstract":"<p><strong>Background and objectives: </strong>While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes.</p><p><strong>Methods: </strong>Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into \"explained cough\" if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or \"unexplained cough\" if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years.</p><p><strong>Results: </strong>The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being \"unexplained\". Participants with unexplained chronic cough had lower FEV<sub>1</sub>/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough.</p><p><strong>Conclusions: </strong>Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":" ","pages":"2416810"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD. 肺康复之外:PICk UP 计划能否填补空白?慢性阻塞性肺病随机试验。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-10-24 DOI: 10.1016/j.pulmoe.2024.04.001
P Rebelo, D Brooks, J Cravo, M A Mendes, A C Oliveira, A S Rijo, M J Moura, A Marques
{"title":"Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD.","authors":"P Rebelo, D Brooks, J Cravo, M A Mendes, A C Oliveira, A S Rijo, M J Moura, A Marques","doi":"10.1016/j.pulmoe.2024.04.001","DOIUrl":"10.1016/j.pulmoe.2024.04.001","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Pulmonary rehabilitation (PR) is a fundamental intervention to manage COPD, however, maintaining its benefits is challenging. Engaging in physical activity might help to prolong PR benefits. This study assessed the efficacy and effectiveness of a personalised community-based physical activity programme to sustain physical activity and other health-related PR benefits, in people with COPD.</p><p><strong>Materials and methods: </strong>This was a multicentre, assessor blinded, randomised controlled trial. Following 12-weeks of PR, people with COPD were assigned to a six-months personalised community-based physical activity programme (experimental group), or to standard care (control group). Physical activity was assessed via: time spent in moderate to vigorous physical activities per day (primary outcome measure), steps/day and the brief physical activity assessment tool. Secondary outcomes included sedentary behaviour, functional status, peripheral muscle strength, balance, symptoms, emotional state, health-related quality of life, exacerbations and healthcare utilization. Assessments were performed immediately post-PR and after three- and six-months. Efficacy and effectiveness were evaluated using intention-to-treat and per-protocol analysis with linear mixed models.</p><p><strong>Results: </strong>Sixty-one participants (experimental group: <i>n</i> = 32; control group: <i>n</i> = 29), with balanced baseline characteristics between groups (69.6 ± 8.5 years old, 84 % male, FEV<sub>1</sub> 57.1 ± 16.7 %predicted) were included. Changes in all physical activity outcomes and in one-minute sit-to-stand were significantly different (<i>P</i> < 0.05) between groups at the six-month follow-up. In the remaining outcomes there were no differences between groups.</p><p><strong>Conclusions: </strong>The community-based physical activity programme resulted in better physical activity levels and sit-to-stand performance, six-months after completing PR, in COPD. No additional benefits were observed for other secondary outcomes.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":" ","pages":"2416827"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application and internal validation of lung ultrasound score in COVID-19 setting: Correspondence. 肺部超声评分在 COVID-19 环境中的应用和内部验证:通讯
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-10-25 DOI: 10.1016/j.pulmoe.2024.06.001
H Daungsupawong, V Wiwanitkit
{"title":"Application and internal validation of lung ultrasound score in COVID-19 setting: Correspondence.","authors":"H Daungsupawong, V Wiwanitkit","doi":"10.1016/j.pulmoe.2024.06.001","DOIUrl":"10.1016/j.pulmoe.2024.06.001","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":" ","pages":"2416863"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Note: The evolution of interstitial cystic lung disease associated with anti-RNP antibodies - A decade-long observational case.
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-11-04 DOI: 10.1080/25310429.2024.2415184
Raphael Lhote, Samia Boussouar, Alexis Mathian, Fleur Cohen Aubart, Zahir Amoura
{"title":"Clinical Note: The evolution of interstitial cystic lung disease associated with anti-RNP antibodies - A decade-long observational case.","authors":"Raphael Lhote, Samia Boussouar, Alexis Mathian, Fleur Cohen Aubart, Zahir Amoura","doi":"10.1080/25310429.2024.2415184","DOIUrl":"https://doi.org/10.1080/25310429.2024.2415184","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"31 1","pages":"2415184"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correspondence: "Maintaining pulmonary rehabilitation benefits: Key factors in COPD patient recovery".
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-11-04 DOI: 10.1080/25310429.2024.2411810
Xingshi Hua, Changhui Li
{"title":"Correspondence: \"Maintaining pulmonary rehabilitation benefits: Key factors in COPD patient recovery\".","authors":"Xingshi Hua, Changhui Li","doi":"10.1080/25310429.2024.2411810","DOIUrl":"https://doi.org/10.1080/25310429.2024.2411810","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"31 1","pages":"2411810"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study. 肺功能的地理差异:多中心横断面BOLD研究的结果。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-12-06 DOI: 10.1080/25310429.2024.2430491
Peter G J Burney, James Potts, Ben Knox-Brown, Gregory Erhabor, Hamid Hacene Cherkaski, Kevin Mortimer, Mahesh Padukudru Anand, David M Mannino, Joao Cardoso, Rana Ahmed, Asma Elsony, Cristina Barbara, Rune Nielsen, Eric Bateman, Stefanni Nonna M Paraguas, Li Cher Loh, Abdul Rashid, Emiel Fm Wouters, Frits Me Franssen, Hermínia Brites Dias, Thorarinn Gislason, Mohammed Al Ghobain, Mohammed El Biaze, Dhiraj Agarwal, Sanjay Juvekar, Fatima Rodrigues, Daniel O Obaseki, Parvaiz A Koul, Imed Harrabi, Asaad A Nafees, Terence Seemungal, Christer Janson, William M Vollmer, Andre Fs Amaral, A Sonia Buist
{"title":"Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study.","authors":"Peter G J Burney, James Potts, Ben Knox-Brown, Gregory Erhabor, Hamid Hacene Cherkaski, Kevin Mortimer, Mahesh Padukudru Anand, David M Mannino, Joao Cardoso, Rana Ahmed, Asma Elsony, Cristina Barbara, Rune Nielsen, Eric Bateman, Stefanni Nonna M Paraguas, Li Cher Loh, Abdul Rashid, Emiel Fm Wouters, Frits Me Franssen, Hermínia Brites Dias, Thorarinn Gislason, Mohammed Al Ghobain, Mohammed El Biaze, Dhiraj Agarwal, Sanjay Juvekar, Fatima Rodrigues, Daniel O Obaseki, Parvaiz A Koul, Imed Harrabi, Asaad A Nafees, Terence Seemungal, Christer Janson, William M Vollmer, Andre Fs Amaral, A Sonia Buist","doi":"10.1080/25310429.2024.2430491","DOIUrl":"10.1080/25310429.2024.2430491","url":null,"abstract":"<p><p>Spirometry is used to determine what is \"unusual\" lung function compared with what is \"usual\" for healthy non-smokers. This study aimed to investigate regional variation in the forced vital capacity (FVC) and in the forced expiratory volume in one second to FVC ratio (FEV<sub>1</sub>/FVC) using cross-sectional data from all 41 sites of the multinational Burden of Obstructive Lung Disease study. Participants (5,368 men; 9,649 women), aged ≥40 years, had performed spirometry, had never smoked and reported no respiratory symptoms or diagnoses. To identify regions with similar FVC, we conducted a principal component analysis (PCA) on FVC with age, age<sup>2</sup> and height<sup>2</sup>, separately for men and women. We regressed FVC against age, age<sup>2</sup> and height<sup>2</sup>, and FEV<sub>1</sub>/FVC against age and height<sup>2</sup>, for each sex and site, stratified by region. Mean age was 54 years (both sexes), and mean height was 1.69 m (men) and 1.61 m (women). The PCA suggested four regions: 1) Europe and richer countries; 2) the Near East; 3) Africa; and 4) the Far East. For the FVC, there was little variation in the coefficients for age, or age<sup>2</sup>, but considerable variation in the constant (men: 2.97 L in the Far East to 4.08 L in Europe; women: 2.44 L in the Far East to 3.24 L in Europe) and the coefficient for height<sup>2</sup>. Regional differences in the constant and coefficients for FEV<sub>1</sub>/FVC were minimal (<1%). The relation of FVC with age, sex and height varies across and within regions. The same is not true for the FEV<sub>1</sub>/FVC ratio.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"31 1","pages":"2430491"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemic after pandemic: Dengue surpasses COVID-19 in number of deaths. 一次又一次大流行:登革热死亡人数超过COVID-19。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2025-01-07 DOI: 10.1080/25310429.2024.2448364
Nathália Mariana Santos Sansone, Luiz Felipe Azevedo Marques, Matheus Negri Boschiero, Lucas Silva Mello, Fernando Augusto Lima Marson
{"title":"Epidemic after pandemic: Dengue surpasses COVID-19 in number of deaths.","authors":"Nathália Mariana Santos Sansone, Luiz Felipe Azevedo Marques, Matheus Negri Boschiero, Lucas Silva Mello, Fernando Augusto Lima Marson","doi":"10.1080/25310429.2024.2448364","DOIUrl":"https://doi.org/10.1080/25310429.2024.2448364","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"31 1","pages":"2448364"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness and use of home high flow nasal cannula in Portugal: Where are we? 葡萄牙家用高流量鼻插管的有效性和使用:我们在哪里?
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-12-10 DOI: 10.1080/25310429.2024.2423556
Cristina Jácome, Mónica Duarte, João Carlos Winck, Salvador Díaz Lobato, Cátia Caneiras
{"title":"Effectiveness and use of home high flow nasal cannula in Portugal: Where are we?","authors":"Cristina Jácome, Mónica Duarte, João Carlos Winck, Salvador Díaz Lobato, Cátia Caneiras","doi":"10.1080/25310429.2024.2423556","DOIUrl":"https://doi.org/10.1080/25310429.2024.2423556","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"31 1","pages":"2423556"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alpha-1 antitrypsin deficiency and Pi*S and Pi*Z SERPINA1 variants are associated with asthma exacerbations. α -1抗胰蛋白酶缺乏和Pi*S和Pi*Z SERPINA1变异与哮喘加重有关。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-10-25 DOI: 10.1016/j.pulmoe.2023.05.002
Elena Martín-González, José M Hernández-Pérez, José A Pérez Pérez, Javier Pérez-García, Esther Herrera-Luis, Ruperto González-Pérez, Orelvis González-González, Elena Mederos-Luis, Inmaculada Sánchez-Machín, Paloma Poza-Guedes, Olaia Sardón, Paula Corcuera, María J Cruz, Francisco J González-Barcala, Carlos Martínez-Rivera, Joaquim Mullol, Xavier Muñoz, José M Olaguibel, Vicente Plaza, Santiago Quirce, Antonio Valero, Joaquín Sastre, Javier Korta-Murua, Victoria Del Pozo, Fabián Lorenzo-Díaz, Jesús Villar, María Pino-Yanes, Mario A González-Carracedo
{"title":"Alpha-1 antitrypsin deficiency and <i>Pi*S</i> and <i>Pi*Z SERPINA1</i> variants are associated with asthma exacerbations.","authors":"Elena Martín-González, José M Hernández-Pérez, José A Pérez Pérez, Javier Pérez-García, Esther Herrera-Luis, Ruperto González-Pérez, Orelvis González-González, Elena Mederos-Luis, Inmaculada Sánchez-Machín, Paloma Poza-Guedes, Olaia Sardón, Paula Corcuera, María J Cruz, Francisco J González-Barcala, Carlos Martínez-Rivera, Joaquim Mullol, Xavier Muñoz, José M Olaguibel, Vicente Plaza, Santiago Quirce, Antonio Valero, Joaquín Sastre, Javier Korta-Murua, Victoria Del Pozo, Fabián Lorenzo-Díaz, Jesús Villar, María Pino-Yanes, Mario A González-Carracedo","doi":"10.1016/j.pulmoe.2023.05.002","DOIUrl":"10.1016/j.pulmoe.2023.05.002","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Asthma is a chronic inflammatory disease of the airways. Asthma patients may experience potentially life-threatening episodic flare-ups, known as exacerbations, which may significantly contribute to the asthma burden. The <i>Pi*S</i> and <i>Pi*Z</i> variants of the <i>SERPINA1</i> gene, which usually involve alpha-1 antitrypsin (AAT) deficiency, had previously been associated with asthma. The link between AAT deficiency and asthma might be represented by the elastase/antielastase imbalance. However, their role in asthma exacerbations remains unknown. Our objective was to assess whether <i>SERPINA1</i> genetic variants and reduced AAT protein levels are associated with asthma exacerbations.</p><p><strong>Materials and methods: </strong>In the discovery analysis, <i>SERPINA1 Pi*S</i> and <i>Pi*Z</i> variants and serum AAT levels were analyzed in 369 subjects from La Palma (Canary Islands, Spain). As replication, genomic data from two studies focused on 525 Spaniards and publicly available data from UK Biobank, FinnGen, and GWAS Catalog (<i>Open Targets Genetics</i>) were analyzed. The associations between <i>SERPINA1 Pi*S</i> and <i>Pi*Z</i> variants and AAT deficiency with asthma exacerbations were analyzed with logistic regression models, including age, sex, and genotype principal components as covariates.</p><p><strong>Results: </strong>In the discovery, a significant association with asthma exacerbations was found for both <i>Pi*S</i> (odds ratio [OR]=2.38, 95% confidence interval [CI]= 1.40-4.04, <i>p</i>-value=0.001) and <i>Pi*Z</i> (OR=3.49, 95%CI=1.55-7.85, <i>p</i>-value=0.003)Likewise, AAT deficiency was associated with a higher risk for asthma exacerbations (OR=5.18, 95%CI=1.58-16.92, <i>p</i>-value=0.007) as well as AAT protein levels (OR= 0.72, 95%CI=0.57-0.91, <i>p</i>-value=0.005). The <i>Pi*Z</i> association with exacerbations was replicated in samples from Spaniards with two generations of Canary Islander origin (OR=3.79, <i>p</i>-value=0.028), and a significant association with asthma hospitalizations was found in the Finnish population (OR=1.12, <i>p</i>-value=0.007).</p><p><strong>Conclusions: </strong>AAT deficiency could be a potential therapeutic target for asthma exacerbations in specific populations.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":" ","pages":"2416870"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Legend score synthesizes Wells, PERC, Geneva, D-dimer and predicts acute pulmonary embolism prior to imaging tests. Legend评分综合了Wells、PERC、Geneva、d -二聚体,并在影像学检查前预测急性肺栓塞。
IF 10.4 2区 医学
Pulmonology Pub Date : 2025-12-31 Epub Date: 2024-10-24 DOI: 10.1016/j.pulmoe.2023.10.002
Yunfeng Zhao, Yi Cheng, Hongwei Wang, He Du, Jinyuan Sun, Mei Xu, Yong Luo, Song Liu, Xuejun Guo, Wei Xiong
{"title":"The Legend score synthesizes Wells, PERC, Geneva, D-dimer and predicts acute pulmonary embolism prior to imaging tests.","authors":"Yunfeng Zhao, Yi Cheng, Hongwei Wang, He Du, Jinyuan Sun, Mei Xu, Yong Luo, Song Liu, Xuejun Guo, Wei Xiong","doi":"10.1016/j.pulmoe.2023.10.002","DOIUrl":"10.1016/j.pulmoe.2023.10.002","url":null,"abstract":"<p><strong>Introduction: </strong>The prediction rules of acute pulmonary embolism(PE) before imaging tests recommended by the commonly used guidelines have low diagnostic efficiency if not combined with D-dimer, therefore it is necessary to seek for a prediction rule with higher diagnostic efficiency.</p><p><strong>Methods: </strong>We designed a new score named Legend by synthesizing the scores of Wells, PERC, and Geneva, as well as D-dimer with patients in the development group(<i>n</i> = 2112), and then validated it in patients of validation group(<i>n</i> = 388). Diagnostic efficiency was also compared between Legend score and Wells+D-dimer (DD), PERC+DD, Geneva+DD, and YEARS+DD(YEAR algorithm).</p><p><strong>Results: </strong>The Legend score comprised active cancer, D-dimer≥1000 ng/mL, DVT symptoms and/or signs, previous venous thromboembolism (VTE) history, and surgery, trauma, or immobilization in the past month. The sensitivity, specificity, Youden index, and area under the curve(AUC) were 0.985, 0.744, 0.729, and (0.861[0.796-0.925], <i>P</i><0.001), respectively, for original Legend score, whereas were 0.982, 0.778, 0.760, and (0.871[0.823-0.920], <i>P</i><0.001), respectively, for simplified Legend score. The Kappa coefficient and P value of McNemar test were 0.988 and 1.000, respectively, between the original and simplified Legend scores. In the validation group, the sensitivity, specificity, Youden index, and C-index were 0.971, 0.749, 0.720, and (0.838[0.781-0.896], <i>P</i><0.001), respectively, for the original Legend score, whereas were 0.986, 0.715, 0.701, and (0.816[0.750-0.880], <i>P</i> = 0.001) respectively, for the simplified Legend score. The Kappa coefficient and P value of McNemar test between original Legend score and Wells+DD, PERC+DD, Geneva+DD, and YEARS+DD were (0.563, 0.001), (0.139, <0.001), (0.631, 0.006), and (0.732, 0.029), respectively. The Kappa coefficient and P value of McNemar test between simplified Legend score and aforementioned scores were (0.675, 0.009), (0.172, <0.001), (0.747, 0.001), and (0.883, 0.012), respectively.</p><p><strong>Discussion: </strong>In view of the fact the Legend score reserves the efficient predictors and eliminates the inefficient ones in Wells, PERC, and revised Geneva scores, and incorporates D-dimer into it, a more efficient, modified, and user-friendly one has replaced the original ones.</p><p><strong>Conclusions: </strong>The Legend score yields excellent diagnostic efficiency with good safety in the pretest prediction of acute PE prior to imaging tests. It also avoids more unnecessary imaging tests than Wells+DD, PERC+DD, Geneva+DD, or YEARS+DD.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":" ","pages":"2416828"},"PeriodicalIF":10.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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