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Ng SHX, Chiam ZY, Chai GT, Kaur P, Yip WF, Low ZJ, Chu J, Tey LH, Neo HY, Tan WS, Hum A. The PROgnostic ModEl for chronic lung disease (PRO-MEL): development and temporal validation. BMC Pulm Med 2024; 24:429. [PMID: 39215286 PMCID: PMC11365240 DOI: 10.1186/s12890-024-03233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Patients with chronic lung diseases (CLDs), defined as progressive and life-limiting respiratory conditions, experience a heavy symptom burden as the conditions become more advanced, but palliative referral rates are low and late. Prognostic tools can help clinicians identify CLD patients at high risk of deterioration for needs assessments and referral to palliative care. As current prognostic tools may not generalize well across all CLD conditions, we aim to develop and validate a general model to predict one-year mortality in patients presenting with any CLD. METHODS A retrospective cohort study of patients with a CLD diagnosis at a public hospital from July 2016 to October 2017 was conducted. The outcome of interest was all-cause mortality within one-year of diagnosis. Potential prognostic factors were identified from reviews of prognostic studies in CLD, and data was extracted from electronic medical records. Missing data was imputed using multiple imputation by chained equations. Logistic regression models were developed using variable selection methods and validated in patients seen from January 2018 to December 2019. Discriminative ability, calibration and clinical usefulness of the model was assessed. Model coefficients and performance were pooled across all imputed datasets and reported. RESULTS Of the 1000 patients, 122 (12.2%) died within one year. Patients had chronic obstructive pulmonary disease or emphysema (55%), bronchiectasis (38%), interstitial lung diseases (12%), or multiple diagnoses (6%). The model selected through forward stepwise variable selection had the highest AUC (0.77 (0.72-0.82)) and consisted of ten prognostic factors. The model AUC for the validation cohort was 0.75 (0.70, 0.81), and the calibration intercept and slope were - 0.14 (-0.54, 0.26) and 0.74 (0.53, 0.95) respectively. Classifying patients with a predicted risk of death exceeding 0.30 as high risk, the model would correctly identify 3 out 10 decedents and 9 of 10 survivors. CONCLUSIONS We developed and validated a prognostic model for one-year mortality in patients with CLD using routinely available administrative data. The model will support clinicians in identifying patients across various CLD etiologies who are at risk of deterioration for a basic palliative care assessment to identify unmet needs and trigger an early referral to palliative medicine. TRIAL REGISTRATION Not applicable (retrospective study).
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Affiliation(s)
- Sheryl Hui-Xian Ng
- Health Services and Outcomes Research, National Healthcare Group, Annex @ National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore.
| | - Zi Yan Chiam
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Gin Tsen Chai
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, Annex @ National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore
| | - Wan Fen Yip
- Health Services and Outcomes Research, National Healthcare Group, Annex @ National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore
| | - Zhi Jun Low
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jermain Chu
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Lee Hung Tey
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Han Yee Neo
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group, Annex @ National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore
| | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore
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Rathi V, Tiwari P, Seth S, Hadda V, Madan K, Agarwal S, Vij A, Hote M, Sahu M, Mittal S, Guleria R, Pandey S, Pandey RM, Mohan A. Profile of patients referred for lung transplant and their transplant-free survival. Lung India 2024; 41:265-271. [PMID: 38953189 PMCID: PMC11302780 DOI: 10.4103/lungindia.lungindia_515_23] [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: 10/25/2023] [Revised: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Lung transplant (LTx) is a potential treatment option for all patients with chronic, end-stage respiratory disease, who are refractory to optimal medical therapy or where no medical therapy exists. In India, LTx is still in its evolving stages and published literature is sparse. The current study was carried out to study the selection criteria for lung transplant and to evaluate the clinical and socio-economic profile of patients referred for the same at a tertiary health care facility. METHODS The study was a descriptive, prospective, observational study. All adults referred for lung transplant were evaluated for clinical and laboratory profiles. All enrolled patients were assessed for presence of referral criteria, listing criteria, contraindications, and willingness for lung transplant. These patients were followed up for 2 years for transplant-free survival, and the Cox proportional hazards model was used to determine independent predictors of all-cause mortality. RESULTS A total of 103 were included in study. The most common diagnosis was interstitial lung disease (57.2%), followed by bronchiectasis (17.5%) and COPD (13.6%). Most patients were referred for LTx at an advanced stage as 90% met listing criteria. Fifty-four (52.4%) patients had an absolute or relative contraindication to transplant; however, the majority of those contraindications were modifiable. Patients with a lower socio-economic status were less likely to be willing for LTx. The median survival was 757 days. A 6-minute walk distance (6MWD) lesser than 250 m was found to be an independent predictor of mortality. CONCLUSION Making patients aware about lung transplant early in their treatment may give them sufficient time to come to terms with their disease and understand the risk and benefits associated. Efforts should be focused on screening and early treatment of reversible contraindications for the eligible patients. Patients with 6MWD < 250 m are at increased risk of mortality.
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Affiliation(s)
- Vidushi Rathi
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, AIIMS, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Shubham Agarwal
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Arti Vij
- Organ Retrieval and Banking Organization, AIIMS, New Delhi, India
| | | | - Manoj Sahu
- Department of CTVS, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
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Silica-associated lung disease in developing countries. Curr Opin Pulm Med 2023; 29:65-75. [PMID: 36695765 DOI: 10.1097/mcp.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is a considerable burden of silica-associated lung diseases in the developing world. This review summarizes the epidemiology of these diseases, especially silicosis and silico-tuberculosis, mitigative efforts and treatment, especially in the context of developing countries. RECENT FINDINGS In 2017, the highest incidence of silicosis was in China, India and Brazil among the developing countries. The prevalence of silicosis amongst exposed workers may vary from 4 to 55%; there is a risk of underestimation because of the 'healthy worker effect'. The permissible exposure limit for respirable silica adopted by governments in developing countries remains higher than the proposed 0.025 mg/m3. Silica exposure in informal or unorganized industries is challenging, as it falls outside statutory controls. Recent efforts on regulation and compensation by various governments in developing countries are encouraging but need proper implementation on the ground. Biomarkers such as club cell protein 16 and imaging methods such as computed tomography may offer earlier and easier detection of silicosis. Advanced silicosis remains incurable; novel treatments such as antifibrotics agents may be potentially effective. SUMMARY Silica-associated lung diseases are prevalent in developing countries. Efforts directed at preventing or minimizing exposure to respirable crystalline silica are required for mitigation.
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Attawar S, Manoly I, Shah U. Lung Transplantation in India: a Brief Review, Landmarks, Indian Scenario, and our Experience. Indian J Surg 2023; 85:1-12. [PMID: 36686557 PMCID: PMC9841148 DOI: 10.1007/s12262-023-03663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Lung transplantation is gaining widespread acceptance as the preferred therapeutic option for selected cases of end-stage lung disease in India. The indications of lung transplantation are increasing, with better post-operative survival, including the COVID affected lung, if we choose our patients well. The national acceptance of expanded criteria in lung donation, streamlining of the process of lung transplantation by governmental, and non-governmental organizations and significant increase in the number of organ donations in India have strengthened the lung transplantation program within the country. Through this article, we describe a brief history, the process, and our experience of lung transplantation since we started our program in 2017 until date.
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Affiliation(s)
- Sandeep Attawar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences, Hyderabad, Telangana India
| | - Imthiaz Manoly
- Cardiothoracic Surgery , Burjeel Hospitals, Abu Dhabi, United Arab Emirates
- Department of Surgery, UAE University, Al Ain, United Arab Emirates
| | - Unmil Shah
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences, Hyderabad, Telangana India
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Abo Elwafa G, Ahmed N, Abou Zeid A, Abo Elhasab M. Noninvasive ventilation in acute exacerbation of interstitial lung diseases. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_40_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Sunder T. The evolution of lung transplantation in India and the current scenario. Indian J Thorac Cardiovasc Surg 2022; 38:211-228. [DOI: [pmid: 34744333 doi: 10.1007/s12055-021-01248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/10/2024] Open
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The evolution of lung transplantation in India and the current scenario. Indian J Thorac Cardiovasc Surg 2021; 38:211-228. [PMID: 34744333 PMCID: PMC8556848 DOI: 10.1007/s12055-021-01248-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
Lung transplantation has come of age in India. This article aims to trace the evolution of lung transplantation in India from its humble beginnings in 1999 to the current scenario spanning a period of 22 years. Right from the passing of the Act legalising deceased organ transplantation, its amendments and rules—to the development of transplant regulatory bodies—both at national and state levels, the journey thus far has been chronicled. Description of the initial cases at sporadic centres which has now proliferated to many centres now across many states has been elaborated on. The impacts on evolution of lung transplantation by the governmental transplant organisations, non-governmental organisations, and the medical professional societies are described. Publications related to lung transplantation from India are mentioned. Situations specific to India, current scenario of lung transplantation, and future directions are discussed. A brief mention of our experience with lung transplantation has also been made.
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Prasad KT, Sehgal IS, Dhooria S, Muthu V, Agarwal R, Behera D, Aggarwal AN. Underutilization of potential donors for lung transplantation at a tertiary care center in North India. Lung India 2019; 36:399-403. [PMID: 31464211 PMCID: PMC6710964 DOI: 10.4103/lungindia.lungindia_299_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Lung transplantation is infrequently performed in India due to several constraints, and whether the poor lung transplantation rates in India are due to a lack of eligible lung donors is unclear. In this study, we explored the availability of donors for lung transplantation. Materials and Methods: This was a retrospective analysis of all brain-dead participants who underwent assessment of eligibility for lung donation between August 2015 and June 2018. All participants underwent a detailed clinical evaluation that included history, physical examination, arterial blood gas analysis, chest radiograph, and bronchoscopy. The final eligibility for lung donation was assessed using the existing “ideal” criteria and the less stringent “extended” criteria. Results: A total of 55 brain-dead participants (41 [74.5%] males) were assessed for eligibility for lung donation. The mean (standard deviation [SD]) age of the participants was 38.4 (17.2) years. The mean (SD) duration of prior invasive mechanical ventilation at the time of assessment was 4 (3.1) days, with a mean (SD) partial pressure of arterial oxygen: inspired oxygen fraction ratio (PaO2:FiO2) of 326.6 (153.5). The proportion of participants who were found suitable for lung donation was 16 (29.1%) and 35 (63.6%) on employing the ideal and the extended criteria, respectively. Inadequate oxygenation status, abnormal chest radiograph, and sepsis were the most common reasons for excluding participants using either criteria. Despite the availability of adequate lung donors, only one lung transplantation could be performed. Conclusion: Even with the most stringent criteria for lung assessment, nearly one-third of the brain-dead participants had lungs suitable for lung transplantation. Lack of eligible lung donors is not a reason for the poor lung transplantation rates in India.
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Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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