Abnormal Oscillometry in a Multicenter Study of Subjects Following Hematopoietic Stem Cell Transplantation (HSCT) Identified as “Normal" at Enrollment
Bibliographic record
Abstract
Abstract Rationale: Oscillometry is a tidal breathing test which may be useful to monitor lung function and screen for early manifestations of pulmonary abnormalities after HSCT. We previously reported that oscillometry is abnormal in patients preparing to undergo HSCT. However, little is known about the sensitivity of oscillometry to identify sub-clinical abnormal pulmonary function in this population. Methods: The TRANSPIRE study (NCT04098445) is an ongoing multi-center prospective observational cohort study of lung injury after HSCT in children. We performed oscillometry (Tremoflo© C100, Thorasys, Montreal, CA) at baseline in a cohort of 148 subjects at 4 centers. Children between the ages of 4 and 21 years were eligible for study, of whom 69 had oscillometry pre HSCT. Subjects were identified as either “screen normal (sN)” or “screen abnormal (sAbn)” at time of enrollment by the site PI. “sAbn” subjects had abnormalities in one or more of the following categories: clinical pulmonary function testing (spirometry and DLCO), radiology, clinical history, and bronchoalveolar lavage (BAL). Following ERS 2020 Guidelines for quality control, oscillometry was measured over recording periods of 30 seconds during tidal breathing using commercial equipment (Tremoflo, Thorasys Ltd, 5-37Hz) in at least three trials targeting a coefficient of variation of <15% in respiratory system resistance at5 Hz(R5) for the lowest frequency reported. Variables reported were X5, X11, LogAX, Fres, LogR5-R19. Linear regression analysis was used to compare Transpire subjects to a cohort of 80 normal control patients studied at Children's Hospital of Philadelphia. Differences in oscillometry outcomes between groups were expressed as a height adjusted coefficient which quantitated the mean difference, or ‘offset’ across the height range measured. Results: TRANSPIRE subjects (sN + sAbn) differed significantly from controls (C) in all measured parameters. Similarly, sN vs controls and sAbn vs controls differed significantly on all parameters. However, there were no statistically significant differences in X5, X11, Log Ax, Fres, or Log R5-R19 between sN and sAbn subjects. Conclusions: In a multicenter study of oscillometry in a cohort of children undergoing HSCT, we found that subjects identified as normal by screening at enrollment in fact had abnormal oscillometry compared to controls. Furthermore, there was not good concordance between our screening tool and oscillometry results, with abnormal oscillometry seen in both screen-normal and screen-abnormal subjects. These findings suggest that patients undergoing HSCT have dysfunction of the respiratory system which may not be recognized when evaluating by spirometry, imaging, BAL, and clinical history.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".