ABSTRACT Objective To systematically evaluate the occurrence proportion and associated factors of respiratory failure during hospitalization in Chinese patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Eight databases (CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, Embase, and Cochrane Library) were searched from inception to March 1, 2026. Studies reporting multivariable‐adjusted odds ratios (ORs) for factors associated with respiratory failure in AECOPD patients were included. The Newcastle–Ottawa Scale was used for quality assessment. A single‐group rate meta‐analysis with Freeman–Tukey double arcsine transformation was performed to pool the occurrence proportion. Subgroup analyses were conducted by study design, geographical region (Qinling–Huaihe Line), and respiratory failure type. Factors associated with respiratory failure were stratified by definitions and cutoff values; only subgroups with ≥ 3 studies were pooled. Results Twenty‐three studies (5 cohort, 18 case–control) with 4212 patients were included. The pooled occurrence proportion of respiratory failure was 41% (95% CI: 0.37–0.46). Meta‐analysis identified nine factors associated with respiratory failure: comorbid cardiac disease (OR = 2.12, 95% CI: 1.68–2.67), advanced age (OR = 1.22, 95% CI: 1.13–1.33), elevated NLR (OR = 1.87, 95% CI: 1.50–2.33), elevated PCT (OR = 2.27, 95% CI: 1.29–4.00), elevated D‐dimer (OR = 1.72, 95% CI: 1.01–2.90), ≥ 2 annual exacerbations (OR = 2.48, 95% CI: 1.71–3.60), higher APACHE II score (OR = 1.29, 95% CI: 1.17–1.43), elevated CRP (OR = 1.13, 95% CI: 1.02–1.24), and decreased FEV1% predicted (OR = 0.81, 95% CI: 0.67–0.99). Model dependence analysis showed that ALB was statistically significant only under the fixed‐effects model but not under the random‐effects model. NE was not statistically significant under either model. Therefore, ALB and NE were not included among the nine factors that were statistically significant in the primary analysis. Conclusion The occurrence proportion of respiratory failure in hospitalized Chinese AECOPD patients is high and associated with comorbidities, clinical characteristics, severity scores, and inflammatory/coagulation markers. These findings support risk identification and monitoring, but prospective studies are needed to validate their predictive and interventional value.
ABSTRACT Introduction For patients undergoing video‐assisted thoracoscopic surgery (VATS) for lung cancer or other pulmonary lesions, effective one‐lung ventilation (OLV) is essential to provide surgical exposure. Bronchial blockers (BBs) are increasingly used for OLV, but the optimal management of their vent port to accelerate lung collapse remains unclear. Methods In this prospective, randomized, controlled trial, 75 patients were allocated to three groups ( n = 25 each): Group 1—BB with vent port closed; Group 2 (control)—BB with vent port open; Group 3—BB with the disconnection technique. Primary outcome was the time to complete lung collapse, which was scored according to the video clips obtained during the operation. Secondary outcomes included intraoperative hypoxemia, blood gas analysis, blocker malposition, perioperative complications, and surgeon satisfaction. Results A total of 72 patients were included in the modified intention‐to‐treat analysis, with 24 patients in each group. Median time to complete lung collapse was 15 min (95% CI: 10–15) in Groups 1 and 3 but was not reached in Group 2 (15/24, 62.5% had not achieved complete collapse by 30 min). In an exploratory 30‐min restricted mean survival time (RMST), complete collapse occurred on average 14.17 min earlier in Group 1 (95% CI: 11.10–17.23) and 12.50 min earlier in Group 3 (95% CI: 9.62–15.38) than in Group 2, with no difference between Groups 1 and 3 (1.67 min, 95% CI: −1.85 to 5.19); time‐averaged hazard ratios were consistent (Group 1 vs. 2, 9.80 [4.22–22.73]; Group 3 vs. 2, 7.63 [3.36–17.31]; Group 1 vs. 3, 1.20 [0.67–2.16]). No significant differences were detected in hypoxemia, blocker malposition, or complications across groups; however, the trial was not powered for safety outcomes. Conclusion In patients aged 18–65 years with ASA I–II and normal pulmonary function undergoing thoracic surgery, the closure of the BB vent port results in a more rapid lung collapse compared to maintaining the vent port open. However, there was no statistically significant difference observed between the vent port closure technique and the disconnection technique regarding the time required for complete lung collapse. Trial Registration ChiCTR identifier: ChiCTR2000039896
ABSTRACT Objective The objectives are to investigate the association between respiratory muscle function and CAT score deterioration in stable chronic obstructive pulmonary disease (COPD) and to develop an internally validated prediction model. Methods This single‐center retrospective cohort study included 203 patients with stable COPD. Clinically significant CAT score deterioration was defined as an increase of ≥ 2 points from baseline within 12 months. Predictors were selected using LASSO Cox regression and incorporated into a multivariable Cox model. Model performance and the incremental value of maximal inspiratory pressure (MIP) and diaphragm thickening fraction (DTF) were evaluated. Results During follow‐up, 62 patients (30.5%) experienced CAT score deterioration. Higher FEV 1 % predicted (HR = 0.973, 95% CI: 0.956–0.990), MIP (HR = 0.974, 95% CI: 0.957–0.992), and DTF (HR = 0.908, 95% CI: 0.853–0.967) were associated with a lower risk, whereas higher baseline CAT scores and more frequent prior exacerbations were associated with a higher risk. The model showed an apparent 12‐month AUC of 0.873 (95% CI: 0.822–0.924), with an optimism‐corrected AUC of 0.859. Adding MIP and DTF increased the 12‐month AUC from 0.801 to 0.873 (ΔAUC = 0.072), with an NRI of 0.527 and an IDI of 0.058. Sensitivity analyses yielded consistent results. Conclusions Lower MIP and DTF were independently associated with a higher risk of CAT score deterioration in stable COPD. Incorporating these parameters provided incremental predictive information beyond conventional clinical predictors. External validation is required.
INTRODUCTION:High-altitude exposure and hypoxia may induce a hypercoagulable state, thereby promoting the development of venous thromboembolism (VTE). Few studies have reported the incidence of VTE among patients with severe community-acquired pneumonia (SCAP) in high-altitude regions. We conducted a study to investigate the prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies of VTE in this patient population. METHODS:We prospectively enrolled 158 adult patients with SCAP admitted to Lhasa People's Hospital between January 1, 2023, and December 31, 2024. All patients underwent lower extremity venous compression ultrasound and/or computed tomography pulmonary angiography examination. Clinical characteristics, including demographic information, medical history, vital signs, laboratory findings, treatments, complications, and clinical outcomes, were compared for patients with and without VTE in these two subgroups. RESULTS:Of the 158 patients, 74 (46.8%) developed VTE, including 68 with DVT, 21 with pulmonary embolism (PE) and 15 with both DVT and PE. A total of 123 (77.8%) patients received VTE prophylaxis, and there was no significant difference in the incidence of VTE among the groups with different prophylactic measures (p = 0.838). Multivariate logistic regression analysis showed an association between lower partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2 ratios ≤ 160 mmHg: odds ratio [OR] = 2.354, 95% confidence interval [CI] 1.025-5.406, p = 0.044), higher D-dimer level (D-dimer levels ≥ 3.0 μg/mL: OR = 2.901, 95% CI 1.329-6.334; p = 0.008), longer bedridden time (bedridden times ≥ 3 days: OR = 3.540, 95% CI 1.494-8.391, p = 0.004), and the occurrence of VTE. A new prediction model including PaO2/FiO2 ratios, D-dimer levels, and bedridden times showed a better performance in predicting VTE (AUC = 0.886; 95% CI 0.826-0.931; sensitivity: 74.3%; specificity: 89.3%) than Padua prediction score (AUC = 0.624) and Caprini prediction score (AUC = 0.622) for patients with SCAP at high-altitude areas (all p < 0.05). The calibration curve of the nomogram model shows good predictive value. The 30-day cumulative survival rate of patients with VTE was significantly lower than that of patients without VTE (p = 0.034). CONCLUSIONS:The prevalence of VTE is unexpectedly high in hospitalized patients with SCAP in high-altitude regions and may be associated with a poor prognosis. Early identification of patients at high risk for VTE and optimization of thromboprophylactic strategies are therefore warranted improve patient outcomes.
Immune checkpoint inhibitors (ICIs) have changed therapeutic selections for advanced non-small cell lung cancer (NSCLC). However, comparative evidence versus chemotherapy through ICI monotherapy and chemo-immunotherapy combination strategies remains incomplete. For this purpose, we conducted a meta-analysis of randomized controlled trials (RCTs) to measure overall survival (OS) and progression-free survival (PFS) outcome improvements in ICI monotherapy or ICI-chemotherapy combined treatment. These interventions take place in adults (≥ 18 years) with advanced/metastatic NSCLC. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses directions were obeyed. PubMed, Scopus, and Web of Science were searched (2021-2024) for RCTs. A total of 7849 articles were retrieved. RCTs (n = 17) qualify inclusion. Hazard ratios (HRs) along with 95% confidence intervals (CIs) for OS and PFS were pooled using random-effects models. The heterogeneity was assessed by I2. Risk of bias was valued with RoB 2. Publication bias and leave-one-out sensitivity analyses were also estimated. ICI monotherapy RCTs (n = 5) significantly enhanced OS (pooled HR = 0.73, 95% CI: 0.64-0.85; p < 0.0001) and PFS (pooled HR = 0.69, 95% CI: 0.49-0.96) with increased heterogeneity (I2 = 90%). Combined ICI-chemotherapy RCTs (n = 12) produced great benefits, with a pooled OS (HR = 0.68, 95% CI: 0.61-0.75; p < 0.00001; I2 = 48%) and pooled PFS (HR = 0.55, 95% CI: 0.50-0.61; p < 0.00001; I2 = 56%). Subgroup analyses proposed durable effects in smaller trials and with pembrolizumab-based treatments. Risk-of-bias valuations underlined concern, primarily for deviations from therapeutic interventions. Sensitivity analyses set robustness, whereas publication bias was limited. ICI-based remedies, especially chemo-immunotherapy, significantly improve OS and PFS. Heterogeneity and experimental-level bias warrant cautious interpretation. Hence, large RCTs are important to choose the best treatment possibility.
