Ultrasound diaphragm activity as a marker of clinical status and prognosis in acute exacerbations of COPD
Bibliographic record
Abstract
Introduction: Diaphragm thickening fraction (TF) is a marker of disease severity in stable COPD. We investigated the natural evolution of TF during an acute exacerbation (AE) and its predictive value as a marker of early readmission. Methods: We prospectively recruited patients with AECOPD requiring hospitalization. Diaphragm ultrasound was performed at 3 time points: <24h of admission (ADM), at discharge (DIS) and 6-8 weeks after discharge, to assess baseline status (BL). Patients were grouped according to the presence of treatment failure (re-hospitalization for persistent symptoms <30 days of discharge). TF was reported as TFtidal%max (ratio of TF during tidal breathing and during maximal inspiration, representing the contractile requirement of tidal breathing). Results: 28 patients were included (71±9 yrs, FEV1 36±13% predicted). 7 patients had treatment failure. In patients without treatment failure, TFtidal%max decreased from ADM to DIS, and further at BL (51±21% vs 35±18 vs 21±9, all p<0.05). In patients with treatment failure, TFtidal%max did not decrease between ADM and DIS (61±21% vs 62±10%, p=0.98) but decreased at BL (11±2%, p<0.05 compared to DIS). At DIS, TFtidal%max was significantly higher in patients that would need re-admission (p=0.001). In ROC analysis, TFtidal%max at DIS had high predictive value for treatment failure (AUROC 0.92, p=0.001, with a cut-off value of 48% showing 100% sensitivity and 76% specificity). Conclusion: TFtidal%max is increased in AECOPD and is responsive to clinical evolution. Its measurement at discharge is a predictive marker of treatment failure. These findings further support the role of diaphragm ultrasound in the management of COPD.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".