Moffett Alexander T, Balasubramanian Aparna, McCormack Meredith C, Aysola Jaya, Halpern Scott D, Weissman Gary E
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA.
medRxiv. 2024 Oct 23:2024.10.22.24315945. doi: 10.1101/2024.10.22.24315945.
European Respiratory Society and American Thoracic Society (ERS/ATS) guidelines for pulmonary function test (PFT) interpretation recommend the use of a normal forced vital capacity (FVC) to exclude restriction. However, this recommendation is based upon a single study from 1999, which was limited to White patients, and used race-specific reference equations that are no longer recommended by ERS/ATS. We sought to reassess the support for this recommendation by calculating the negative predictive value (NPV) of a normal FVC in a diverse, multicenter cohort using race-neutral reference equations.
We interpreted PFTs performed between 2000 and 2023 in two academic medical systems and in a national electronic health record (EHR) database. We calculated the NPV of a normal FVC to exclude restriction overall and among pre-specified racial and ethnic groups.
We included PFTs from 85990 patients. The prevalence of restriction was 35.1%. The overall NPV of a normal FVC to exclude restriction was 80.5% (95% CI 80.1% to 80.8%), compared to an NPV of 97.6% cited in support of ERS/ATS guidelines. The NPV ranged from 65.2% (95% CI 64.4% to 66.0%) among non-Hispanic Black patients to 85.9% (95% CI 85.6% to 86.3%) among non-Hispanic White patients. This difference was largely attributable to lower FVC z-scores among non-Hispanic Black patients.
The NPV of a normal FVC is lower than has been previously reported and varies by race and ethnicity. The approach to PFT interpretation recommended by ERS/ATS guidelines results in the under-recognition of restriction, particularly among non-Hispanic Black patients.
欧洲呼吸学会和美国胸科学会（ERS/ATS）关于肺功能测试（PFT）解读的指南建议使用正常的用力肺活量（FVC）来排除限制性通气功能障碍。然而，这一建议基于1999年的一项单一研究，该研究仅限于白人患者，并使用了种族特异性参考方程，而ERS/ATS已不再推荐使用这些方程。我们试图通过使用种族中性参考方程计算多中心、多样化队列中正常FVC的阴性预测值（NPV），来重新评估对这一建议的支持情况。
我们解读了2000年至2023年期间在两个学术医疗系统和一个国家电子健康记录（EHR）数据库中进行的PFT。我们计算了正常FVC排除限制性通气功能障碍的总体NPV以及预先指定的种族和族裔群体中的NPV。
我们纳入了85990名患者的PFT数据。限制性通气功能障碍的患病率为35.1%。正常FVC排除限制性通气功能障碍的总体NPV为80.5%（95%置信区间80.1%至80.8%），而支持ERS/ATS指南所引用的NPV为97.6%。NPV范围从非西班牙裔黑人患者中的65.2%（95%置信区间64.4%至66.0%）到非西班牙裔白人患者中的85.9%（95%置信区间85.6%至86.3%）。这种差异主要归因于非西班牙裔黑人患者中较低的FVC z评分。
正常FVC的NPV低于先前报道的水平，并且因种族和族裔而异。ERS/ATS指南推荐的PFT解读方法导致对限制性通气功能障碍的识别不足，尤其是在非西班牙裔黑人患者中。
