An extensive bundle of tests is needed to detect treatable causes of bronchiectasis (Bx)
Bibliographic record
Abstract
Introduction: International guidelines suggest a limited bundle of tests to investigate Bx etiology. We aimed to evaluate an extensive bundle performed on every patient to increase the chances to identify a treatable etiology. Methods: A prospective, observational study was conducted at Policlinico Hospital in Milan, Italy, from 2014 to 2017. All consecutive adults with Bx underwent the following tests: CBC, Aspergillus IgG and IgE, serum electrophoresis, sweat test and genetics for cystic fibrosis, immunoglobulins, IgG subclasses, lymphocytes subsets, nasal NO, autoantibodies, serum level and genetics for alpha1-antitrypsin deficiency (AATD). Bx etiologies identified based on the results of this extensive bundle were compared to etiologies identified based on the results of tests suggested by the BTS 2010 guidelines. Treatable etiologies were considered according to Lonni (Ann Am Thorac Soc 2015). Results: 125 Bx patients (74% female, median age 65 years) were enrolled. Following the extensive bundle of test, a decrease in both idiopathic (50% vs. 62%) and post-infective Bx (8% vs. 10%), and an increase in Bx due to any immunodeficiency (18% vs. 4%, p<0.001), IgG subclass (14% vs 0%, p<0.001) and secondary immunodeficiency (8% vs. 3%), as well as AATD (2.4% vs 0.8%), were found in comparison to the BTS2010 bundle. Using this extensive bundle of tests the percentage of patients with a treatable etiology was more than double in comparison to what could have been found using the BTS 2010 bundle (37% vs. 17%, p<0.001). Conclusion: Physicians should consider an extensive bundle of tests to evaluate the etiology of the disease in every Bx patient regardless her/his characteristics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".