BACKGROUND AND OBJECTIVE:Transitioning from ethnic-specific (GLI-2012) to race-neutral (GLI-2022) reference equations may change the interpretation of spirometric data and the classification of ventilatory defects, but the evidence from Southeast Asian populations remain uncertain. This study evaluated the agreement between GLI-2012 and GLI-2022 interpretation frameworks in a Southeast Asian cohort. METHODS:This cross-sectional study included 265 consecutive Southeast Asian patients who underwent pre-bronchodilator spirometry at a tertiary hospital in Vietnam. Each examination was interpreted using both reference equations. Reclassification was described with transition probabilities, agreement proportions, and prevalence- and bias-adjusted kappa (PABAK), with BCa bootstrap 95% confidence intervals. Bland-Altman method was used for quantitative agreement analysis. RESULTS:Four-pattern concordance was high (pooled union agreement, 80.27%; multicategory PABAK of 0.854), yet 29 of 265 participants (10.9%) changed ATS/ERS pattern. GLI-2022 produced higher predicted FEV1 and FVC values and lower predicted FEV1/FVC values, yielding lower FEV1 and FVC z-scores and higher FEV1/FVC z-scores. Reclassification predominantly shifted toward possible restriction or non-specific pattern (20.75% to 27.92%), whereas obstruction decreased modestly (7.55% to 4.15%). Between-framework bias was nonconstant; at the LLN, the expected differences (95% conditional prediction intervals) for FEV1, FVC, and FEV1/FVC were -0.129 (-0.436 to 0.178), -0.229 (-0.572 to 0.115), and +0.381 (0.175 to 0.586), respectively. CONCLUSION:In this tertiary-care cohort of Southeast Asian patients, race-neutral equations produced systematic, scale-dependent shifts and reclassification of spirometric results, particularly affecting obstruction and low-FVC patterns. Longitudinal, outcome-based validation is required to determine the clinical implications of adopting race-neutral reference equations.
BACKGROUND:Exhaled volatile organic compound (VOC) profiling is a promising non-invasive tool for disease diagnosis, but its clinical value in general critical illness remains underexplored. This study investigated whether exhaled breath VOC signatures can distinguish critically ill patients from healthy controls, stratify disease severity, and predict short-term prognosis in a heterogeneous intensive care unit (ICU) population. METHODS:We conducted a prospective observational study enrolling 278 consecutive ICU patients and 145 healthy controls. Exhaled VOC profiles were collected via gas chromatography-ion mobility spectrometry (GC-IMS). Differential VOC analysis was performed, and an orthogonal partial least squares-discriminant analysis (OPLS-DA) model was constructed to evaluate diagnostic accuracy, stratification capacity, and prognostic performance. RESULTS:A total of 862 exhaled breath samples were analyzed, identifying 28 of 44 detected VOC signals. Eight of these compounds showed significant abundance alterations in ICU patients relative to controls. The OPLS-DA model achieved an area under the receiver operating characteristic curve (AUC) of 0.97 for distinguishing ICU patients from healthy individuals. VOC profiles also differed significantly between patients stratified by high vs. low APACHE Ⅱ scores. For predicting 30-day all-cause mortality, the model yielded a moderate AUC of 0.73, with 3 specific VOCs (2-Butanone-3-hydroxy-D, ethyl acetate-M, and dimethyl sulfide) showing significant abundance differences between non-survivors and patients with clinical improvement. CONCLUSIONS:Exhaled VOC profiling effectively identifies critical illness and stratifies disease severity. While single-modal VOC profiling has limited prognostic performance due to the heterogeneity of critical illness outcomes, the distinct differential signatures identified here provide a solid foundation for future research.
BACKGROUND:Respiratory symptoms in Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorders (G-HSD) may negatively impact health-related quality of life (HRQL) and daily functioning. EDS/G-HSD patients report unmet respiratory symptom management needs that are poorly understood. OBJECTIVES:1) characterize respiratory symptoms and their associations with HRQL, physical activity, and patient-reported outcomes in EDS/G-HSD; and 2) explore respiratory symptom management needs and their impact on daily function. METHODS:We conducted a mixed-methods study at the GoodHope EDS Clinic with EDS or G-HSD participants who reported respiratory symptoms or a respiratory condition. Patient-reported outcomes, Fitbit-measured physical activity, and qualitative interviews were undertaken to assess dyspnea severity, HRQL, fatigue, sleep quality, and mental and physical function. RESULTS:Moderate to severe dyspnea (MRC ≥ 2) was reported by 74.5% of participants (n=35/47). Dyspnea (MRC ≥ 2) was associated with lower Short Form-36 physical component score (-16.9 points [-23.4 to -10.3], p<0.001), greater fatigue severity score (11.3 [4.7 to 18.0], p=0.014), and reduced functional capacity on the Duke Activity Status Index (-14.6 [-23.4 to -5.8], p<0.001). Over half of the participants (12/21, 57%) demonstrated sedentary activity levels (<5000 median steps/day). Qualitative interviews revealed dyspnea-related limitations with daily activities and social participation, with patients reporting a "cycle of inactivity" driven by symptom burden. CONCLUSION:Dyspnea is prevalent in EDS/G-HSD and is associated with reduced physical function and HRQL. These findings highlight the need to systematically assess respiratory symptoms through interdisciplinary care in this population.
RATIONALE:Emergency Room visits are common in patients with idiopathic pulmonary fibrosis but their association with clinical outcomes is unknown. OBJECTIVES:We sought to determine the association of ER visits not associated with subsequent hospitalization in patients with idiopathic pulmonary fibrosis on transplant-free survival. METHODS:An analysis of the Pulmonary Fibrosis Foundation Patient Registry data was performed. Transplant-free survival was compared between patients with idiopathic pulmonary fibrosis who had (1) no emergency room visits or hospitalizations (2) emergency room visits without a resulting hospitalization and (3) inpatient hospitalization. OUTCOMES:Data from a total of 1226 IPF participants in the PFF Registry followed for a mean of 976. 8 days (SD of 530.9) was analyzed. 416 participants (33.9%) were hospitalized and 103 participants (8.9%) had ER visits that didn't result in hospitalization. Unadjusted Cox regression model found no difference in transplant-free survival between participants with ER visit only (HR 0.78, 95% CI 0.55,1.12) and those with no hospital visit; however, participants with inpatient (IP) hospitalization events did manifest a decreased transplant-free survival (HR 1.40, 95% CI 1.17,1.695) relative to those with no hospital visits. Unadjusted univariate Cox regression analysis comparing respiratory-related ER visits to no hospitalization failed to demonstrate a significant difference in transplant-free survival (HR 1.49, 95% CI 0.88, 2.51). CONCLUSIONS:IPF patients experiencing ER visits not resulting in hospitalization do not appear to be at an increased risk of death or transplantation in comparison to patients not having an ER visit.
