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Mangseth H, Sikkeland LIB, Durheim MT, Ulvestad M, Myrdal OH, Kongerud J, Lund MB. Comparison of different reference values for lung function: implications of inconsistent use among centers. BMC Pulm Med 2023; 23:137. [PMID: 37095462 PMCID: PMC10127329 DOI: 10.1186/s12890-023-02430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND For interpretation of pulmonary function tests (PFTs), reference values based on sex, age, height and ethnicity are needed. In Norway, the European Coal and Steel Community (ECSC) reference values remain widely used, in spite of recommendations to implement the more recent Global Lung Function Initiative (GLI) reference values. OBJECTIVE To assess the effects of changing from ECSC to GLI reference values for spirometry, DLCO and static lung volumes, using a clinical cohort of adults with a broad range in age and lung function. METHODS PFTs from 577 adults (18-85 years, 45% females) included in recent clinical studies were used to compare ECSC and GLI reference values for FVC, FEV1, DLCO, TLC and RV. Percent predicted and lower limit of normal (LLN) were calculated. Bland-Altman plots were used to assess agreement between GLI and ECSC % predicted values. RESULTS In both sexes, GLI % predicted values were lower for FVC and FEV1, and higher for DLCO and RV, compared to ECSC. The disagreement was most pronounced in females, with mean (SD) difference 15 (5) percent points (pp) for DLCO and 17 (9) pp for RV (p < 0.001). With GLI, DLCO was below LLN in 23% of the females, with ECSC in 49% of the females. CONCLUSIONS The observed differences between GLI and ECSC reference values are likely to entail significant consequences with respect to criteria for diagnostics and treatment, health care benefits and inclusion in clinical trials. To ensure equity of care, the same reference values should be consistently implemented across centers nationwide.
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Affiliation(s)
- Henrik Mangseth
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway.
| | - Liv Ingunn Bjoner Sikkeland
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael Thomas Durheim
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mariann Ulvestad
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Henrik Myrdal
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johny Kongerud
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May B Lund
- Department of Respiratory Medicine, Oslo University Hospital, Sognsvannsveien, Rikshospitalet, Oslo, 20,0372, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chronic Lung Allograft Dysfunction Is Associated with Increased Levels of Cell-Free Mitochondrial DNA in Bronchoalveolar Lavage Fluid of Lung Transplant Recipients. J Clin Med 2022; 11:jcm11144142. [PMID: 35887906 PMCID: PMC9322792 DOI: 10.3390/jcm11144142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic Lung Allograft Dysfunction (CLAD) is a life-threatening complication that limits the long-term survival of lung transplantation patients. Early diagnosis remains the basis of efficient management of CLAD, making the need for distinctive biomarkers critical. This explorative study aimed to investigate the predictive power of mitochondrial DNA (mtDNA) derived from bronchoalveolar lavages (BAL) to detect CLAD. The study included 106 lung transplant recipients and analyzed 286 BAL samples for cell count, cell differentiation, and inflammatory and mitochondrial biomarkers, including mtDNA. A receiver operating curve analysis of mtDNA levels was used to assess its ability to detect CLAD. The results revealed a discriminatory pro-inflammatory cytokine profile in the BAL fluid of CLAD patients. The concentration of mtDNA increased in step with each CLAD stage, reaching its highest concentration in stage 4, and correlated significantly with decreasing FEV1. The receiver operating curve analysis of mtDNA in BAL revealed a moderate prediction of CLAD when all stages were grouped together (AUROC 0.75, p-value < 0.0001). This study has found the concentration mtDNA in BAL to be a potential predictor for the early detection of CLAD and the differentiation of different CLAD stages, independent of the underlying pathology.
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