Causal association between cigarette smoking and the prevalence of preserved ratio impaired spirometry (PRISm), and the progression risk factors of PRISm: A study based on Mendelian randomization and meta-analysis
Bibliographic record
Abstract
INTRODUCTION Preserved ratio impaired spirometry (PRISm) is a new and variable phenotype of spirometry impairment that was first defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2023.The identification of high-risk factors for the progression from PRISm to COPD remains insufficient at present.METHODS Mendelian randomization (MR) analysis was conducted using genomewide association study (GWAS) summary statistics.Genetic instruments for smoking behavior were derived from the GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN) (n=607291), while PRISm case-control data were sourced from the UK Biobank (n=296282).The inverse-variance weighted (IVW) method served as the primary analytical approach, supplemented by heterogeneity assessment, pleiotropy evaluation, and sensitivity analyses.For the meta-analysis, PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to 31 December 2024, to identify relevant studies that followed up on the changes in spirometry among individuals with PRISm or studies that reported the possible factors related to the changes in spirometry among individuals with PRISm.The risk of bias and the quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS). RESULTSThe MR analysis identified 85 SNPs as genetic instruments, revealing a modest causal link between cigarette smoking and PRISm prevalence (IVW: OR=1.01-1.02,p=0.048).The meta-analysis of 14 studies (n=7336 PRISm cases) shows 20.8% (95% CI: 15.6-25.9)progress to COPD at follow-up, with no significant difference by follow-up duration (<5 vs ≥5 years).Persistent PRISm occurs in 41.5% (95% CI: 35.8-47.2),more frequently in long-term follow-up subgroups.Baseline 'chest distress/dyspnea' (OR=3.81;95% CI: 1.47-9.84)and 'current smoking' (OR=2.18;95% CI: 1.14-4.15)significantly predict progression, while respiratory symptoms, FEV 1 /FVC ratio, TLC%, and FVC% show no association.CONCLUSIONS Our findings suggest a modest causal link between cigarette smoking and PRISm prevalence.The progression of PRISm to COPD within 5 years is approximately 20.8%.Among individuals with PRISm at the first visit, 'chest distress or dyspnea' and 'current smoking' are potential clinical risk factors for the progression of PRISm to 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 | 0.026 | 0.048 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.037 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".