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Performance Characteristics for Physiological Measures of Progressive Pulmonary Fibrosis.

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Název: Performance Characteristics for Physiological Measures of Progressive Pulmonary Fibrosis.
Autoři: Newton CA; Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., Thenappan A; Department of Internal Medicine., Liu GY; Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California., Yazbeck L; National Heart and Lung Institute, Imperial College London, London, United Kingdom.; Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Lee CT; Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois., Pugashetti JV; Division of Pulmonary and Critical Care Medicine, and., Wang JM; Division of Pulmonary and Critical Care Medicine, and., White E; Division of Pulmonary and Critical Care Medicine, and., Flaherty KR; Division of Pulmonary and Critical Care Medicine, and., Belloli EA; Division of Pulmonary and Critical Care Medicine, and., Sheth JS; Division of Pulmonary and Critical Care Medicine, and., Mohan N; Division of Pulmonary and Critical Care Medicine, and., Nazemi N; Division of Pulmonary and Critical Care Medicine, and., Yu AR; Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., Ghodrati S; Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California., Johannson KA; Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Marcoux V; Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada., Fisher JH; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Assayag D; Department of Medicine, McGill University, Montreal, Quebec, Canada., Manganas H; Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada., Khalil N; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Kolb M; Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada., Morisset J; Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada., Garcia CK; Division of Pulmonary and Critical Care Medicine, Columbia University, New York, New York., Chua F; National Heart and Lung Institute, Imperial College London, London, United Kingdom.; Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Strek ME; Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois., Khor YH; Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; and.; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia., Adegunsoye A; Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois., Ryerson CJ; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Molyneaux PL; National Heart and Lung Institute, Imperial College London, London, United Kingdom.; Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Oldham JM; Division of Pulmonary and Critical Care Medicine, and.; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
Zdroj: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2025 Oct; Vol. 211 (10), pp. 1867-1875.
Způsob vydávání: Journal Article; Multicenter Study; Observational Study
Jazyk: English
Informace o časopise: Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
Imprint Name(s): Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
Výrazy ze slovníku MeSH: Pulmonary Fibrosis*/physiopathology , Pulmonary Fibrosis*/diagnosis , Pulmonary Fibrosis*/mortality , Respiratory Function Tests*, Aged ; Female ; Humans ; Male ; Middle Aged ; Canada ; Disease Progression ; Retrospective Studies ; ROC Curve ; United Kingdom ; United States ; Vital Capacity
Abstrakt: Rationale: Clinical measures of progressive pulmonary fibrosis (PPF) have been proposed, but their clinical utility remains unclear. Objectives: To determine performance characteristics of lung function-based PPF measures, including new guideline criteria for discriminating clinically relevant outcomes. Methods: A multicenter retrospective cohort analysis was performed to assess the performance characteristics of eight categorical measures of FVC and Dl CO decline, together with PPF guideline criteria (requiring two of the following: worsening respiratory symptoms, absolute decline in FVC ⩾5% or Dl CO ⩾15%, or radiological progression) for discriminating 2-year death or lung transplant among patients fibrotic interstitial lung disease from the United States, United Kingdom, and Canada ( n  = 2,727). The net benefit of the top-performing measures to inform treatment initiation were compared using decision curves. Measurements and Main Results: PPF classified according to relative decline in FVC of ⩾10%, relative decline in Dl CO of ⩾15%, and PPF guideline criteria displayed the best overall test performance, with area under the receiver operating characteristic curves of 0.67-0.68. Specificity was higher than sensitivity for all evaluated measures, with relative measures of lung function decline outperforming absolute measures. The net benefit of standalone relative decline in FVC ⩾10% and Dl CO ⩾15% was similar to PPF guideline criteria across the range of treatment probability thresholds. Conclusions: Classifying PPF by standalone measures of FVC and Dl CO decline provides clinical utility similar to PPF guideline criteria. Top-performing physiology-based measures of PPF discriminate outcomes with high specificity but low sensitivity.
Komentáře: Comment in: Am J Respir Crit Care Med. 2025 Oct;211(10):1751-1752. doi: 10.1164/rccm.202505-1152ED.. (PMID: 40600929)
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Grant Information: T32 HL007749 United States HL NHLBI NIH HHS; K23HL148498 United States HL NHLBI NIH HHS; R01 HL166290 United States HL NHLBI NIH HHS; United States Asthma+Lung UK; K23HL146942 United States HL NHLBI NIH HHS; T32HL007605 United States HL NHLBI NIH HHS; R56HL158935 United States HL NHLBI NIH HHS; K23HL138190 United States HL NHLBI NIH HHS; K23 HL146942 United States HL NHLBI NIH HHS; T32 HL007605 United States HL NHLBI NIH HHS; UL1 TR001105 United States TR NCATS NIH HHS; T32 HL007013 United States HL NHLBI NIH HHS; R01 HL093096 United States HL NHLBI NIH HHS; T32HL007013 United States HL NHLBI NIH HHS; R56 HL158935 United States HL NHLBI NIH HHS; R01HL093096 United States HL NHLBI NIH HHS; K23 HL148498 United States HL NHLBI NIH HHS; United States Boehringer Ingelheim; R01 HL169166 United States HL NHLBI NIH HHS; UL1TR001105 United States TR NCATS NIH HHS; K23 HL138190 United States HL NHLBI NIH HHS; T32HL007749 United States HL NHLBI NIH HHS
Contributed Indexing: Keywords: idiopathic pulmonary fibrosis; interstitial lung disease; progressive fibrosing interstitial lung disease; progressive pulmonary fibrosis; test performance characteristics
Entry Date(s): Date Created: 20250618 Date Completed: 20250926 Latest Revision: 20251018
Update Code: 20251018
PubMed Central ID: PMC12525792
DOI: 10.1164/rccm.202501-0317OC
PMID: 40530983
Databáze: MEDLINE
Popis
Abstrakt:Rationale: Clinical measures of progressive pulmonary fibrosis (PPF) have been proposed, but their clinical utility remains unclear. Objectives: To determine performance characteristics of lung function-based PPF measures, including new guideline criteria for discriminating clinically relevant outcomes. Methods: A multicenter retrospective cohort analysis was performed to assess the performance characteristics of eight categorical measures of FVC and Dl <subscript>CO</subscript> decline, together with PPF guideline criteria (requiring two of the following: worsening respiratory symptoms, absolute decline in FVC ⩾5% or Dl <subscript>CO</subscript> ⩾15%, or radiological progression) for discriminating 2-year death or lung transplant among patients fibrotic interstitial lung disease from the United States, United Kingdom, and Canada ( n  = 2,727). The net benefit of the top-performing measures to inform treatment initiation were compared using decision curves. Measurements and Main Results: PPF classified according to relative decline in FVC of ⩾10%, relative decline in Dl <subscript>CO</subscript> of ⩾15%, and PPF guideline criteria displayed the best overall test performance, with area under the receiver operating characteristic curves of 0.67-0.68. Specificity was higher than sensitivity for all evaluated measures, with relative measures of lung function decline outperforming absolute measures. The net benefit of standalone relative decline in FVC ⩾10% and Dl <subscript>CO</subscript> ⩾15% was similar to PPF guideline criteria across the range of treatment probability thresholds. Conclusions: Classifying PPF by standalone measures of FVC and Dl <subscript>CO</subscript> decline provides clinical utility similar to PPF guideline criteria. Top-performing physiology-based measures of PPF discriminate outcomes with high specificity but low sensitivity.
ISSN:1535-4970
DOI:10.1164/rccm.202501-0317OC