纤维间质性肺病新发运动性和静息性低氧血症的预测。

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM
Ferhan Saleem, Christopher J Ryerson, Nandini Sarma, Kerri Johannson, Veronica Marcoux, Jolene Fisher, Deborah Assayag, Helene Manganas, Nasreen Khalil, Julie Morisset, Ian N Glaspole, Nicole Goh, Justin M Oldham, Gerard Cox, Charlene Fell, Andrea S Gershon, Andrew Halayko, Nathan Hambly, Stacey D Lok, Shane Shapera, Teresa To, Pearce G Wilcox, Alyson W Wong, Martin Kolb, Yet H Khor
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引用次数: 1

摘要

理由:纤维化间质性肺病(ILD)的低氧血症表明疾病进展,具有预后意义。低氧血症的发作预示着纤维化间质性肺病(ILD)的疾病进展和死亡率。准确预测新发的运动性和静息性低氧血症促使患者进行适当的讨论,并及时考虑家庭氧气。目的:我们推导并外部验证了一种新发运动性和静息性低氧血症的风险预测工具。方法:本研究使用加拿大的ILD登记作为衍生队列,使用澳大利亚和美国的ILD注册作为验证队列。新发劳力性低氧血症和静息低氧血症被定义为最低点SpO2结果:新发劳力型低氧血症和静止低氧血症的最佳预测模型包括年龄、体重指数、特发性肺纤维化的诊断以及预测的强迫肺活量和一氧化碳扩散能力的百分比。风险预测工具在衍生队列中表现出良好的运动性低氧血症(C指数=0.70,GoF=0.85)和静息低氧血症(C-指数=0.77,GoF=0.027)表现,除静息低氧血症校正外,在验证队列中表现相似(GoF=0.001)。结论:该临床适用的风险预测工具预测了衍生队列和不同验证队列中6个月时新发的运动性和静息性低氧血症。验证队列中的次优GoF可能反映了对低氧血症风险的高估,并表明该模型没有因低估低氧血症而存在缺陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predicting New-onset Exertional and Resting Hypoxemia in Fibrotic Interstitial Lung Disease.

Rationale: Hypoxemia in fibrotic interstitial lung disease (ILD) indicates disease progression and is of prognostic significance. The onset of hypoxemia signifies disease progression and predicts mortality in fibrotic ILD. Accurately predicting new-onset exertional and resting hypoxemia prompts appropriate patient discussion and timely consideration of home oxygen. Objectives: We derived and externally validated a risk prediction tool for both new-onset exertional and new-onset resting hypoxemia. Methods: This study used ILD registries from Canada for the derivation cohort and from Australia and the United States for the validation cohort. New-onset exertional and resting hypoxemia were defined as nadir oxyhemoglobin saturation < 88% during 6-minute-walk tests, resting oxyhemoglobin saturation < 88%, or the initiation of ambulatory or continuous oxygen. Candidate predictors included patient demographics, ILD subtypes, and pulmonary function. Time-varying Cox regression was used to identify the top-performing prediction model according to Akaike information criterion and clinical usability. Model performance was assessed using Harrell's C-index and goodness-of-fit (GoF) likelihood ratio test. A categorized risk prediction tool was developed. Results: The best-performing prediction model for both new-onset exertional and new-onset resting hypoxemia included age, body mass index, a diagnosis of idiopathic pulmonary fibrosis, and percent predicted forced vital capacity and diffusing capacity of carbon monoxide. The risk prediction tool exhibited good performance for exertional hypoxemia (C-index, 0.70; GoF, P = 0.85) and resting hypoxemia (C-index, 0.77; GoF, P = 0.27) in the derivation cohort, with similar performance in the validation cohort except calibration for resting hypoxemia (GoF, P = 0.001). Conclusions: This clinically applicable risk prediction tool predicted new-onset exertional and resting hypoxemia at 6 months in the derivation cohort and a diverse validation cohort. Suboptimal GoF in the validation cohort likely reflected overestimation of hypoxemia risk and indicated that the model is not flawed because of underestimation of hypoxemia.

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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
发文量
0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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