Daily Respiratory Research Analysis

Lower respiratory tract infections (LRTI) are a leading cause of mortality and are challenging to diagnose in critically ill patients, as non-infectious causes of respiratory failure can present with similar clinical features. We develop an LRTI diagnostic method combining the pulmonary transcriptomic biomarker FABP4 with electronic medical record text assessment using the large language model Generative Pre-trained Transformer 4. In a cohort of critically ill adults, a combined classifier incorporating FABP4 expression and large language model electronic medical record analysis achieves an area under the receiver operating characteristic curve (AUC) of 0.93 ± 0.08 and an accuracy of 84%, outperforming FABP4 expression alone (0.84 ± 0.11) and large language model-based analysis alone (0.83 ± 0.07). By comparison, the medical team admission diagnosis has an accuracy of 72%. In an independent validation cohort, the combined classifier yields an AUC of 0.98 ± 0.04 and accuracy of 96%. This study suggests that integrating a host biomarker with large language model analysis can improve LRTI diagnosis in critically ill adults.

BACKGROUND: The benefits of preoxygenation with noninvasive respiratory support (NRS), including high-flow oxygen therapy (HFOT) and noninvasive ventilation (NIV), compared to conventional oxygen therapy (COT) during emergency endotracheal intubation (ETI) remain unclear. This network meta-analysis aims to evaluate whether preoxygenation with NRS is more effective than COT in minimising the lowest recorded peripheral capillary oxygen saturation ( METHODS: A comprehensive literature search was conducted (PROSPERO-CRD42024606842) across Medline, Embase and Scopus. The PICOS criteria were: P: critically ill adult patients requiring emergency ETI; I: randomisation for receiving preoxygenation with NRS; C: randomisation for COT; O: the lowest recorded RESULTS: 15 RCTs (2939 patients) met the inclusion criteria. Compared to COT, all NRS methods improved the lowest INTERPRETATION: During emergency ETI in critical care areas, despite a low certainty of evidence, preoxygenation with NRS overperformed COT in maintaining

BACKGROUND: Sex-based differences in morbidity and mortality in pulmonary hypertension (PH) are underexplored, yet understanding these differences is vital for improving clinical management. This study investigates the influence of sex on survival of patients with PH in dependency of various disease conditions. METHODS: The PVRI GoDeep meta-registry integrates data from international PH registries, of which we analysed 21,123 incident hemodynamically fully characterised patients with PH. Survival analyses employed Kaplan-Meier and Cox proportional hazards models, adjusted for confounders and subjected to sensitivity analyses. FINDINGS: Male patients consistently showed significantly higher mortality than females across the overall PH population (hazard ratio 1.36 [1.23, 1.50] after adjustment) and within PAH and non-PAH groups. These sex differences in survival persisted regardless of P(A)H severities, age and obesity, cardiovascular diseases, and PAH-specific therapies. The male survival disadvantage was noted across low-, intermediate-, and high-risk groups of the ESC/ERS 2022, REVEAL lite 2, and COMPERA 4-strata scores, but not the REVEAL 2.0 risk score, which incorporates male sex as non-modifiable factor. Stratification by race revealed that male sex was associated with worse survival in White patients, but not in Black or Asian patients with PH. INTERPRETATION: Male patients with PH exhibit significantly higher mortality risks than females across both PAH and non-PAH PH groups. This disparity persists regardless of PH severity, underlying cause, age, obesity, comorbidities, or treatment status, though race might modify the observed risk difference. These insights provide new avenues for investigating underlying mechanisms and suggest including male sex as an independent factor in clinical risk assessment tools. FUNDING: This work is funded by the Pulmonary Vascular Research Institute (PVRI) and the Cardiovascular Medical Research and Education Fund (CMREF), NIH.