Work

Comparison of two spirometry reference equations in predicted FEV1 quantification and its effects on hematopoietic cell transplantation‐specific comorbidity index (HCT‐CI)

Year: 2022

Type: article

Abstract: We compared the obtained values of the expected percentage of FEV1 by applying the European Coal and Steel Community (ECSC) prediction equation1 and the Global Lung Function Initiative (GLI) prediction equation1 and evaluated the impact on the obtained scoring on the criterion designated as pulmonary disease on the hematopoietic cell transplant specific comorbidity index (HCT-CI) score.2 Several risk scores have been developed which are able to support the clinician when considering the risks and benefits of transplant of hematopoietic cells (HCT) in an individualized and systematic way. HCT-CI is an efficient and valid score that has become a widely used tool in the evaluation of the pretransplant patient of hematopoietic cells.2, 3 The presence and/or severeness of the pulmonary disease are criteria that are included in this score evaluated according to values of the expected percentage of capacity of the alveolocapillary diffusing capacity of the carbon monoxide (%DLCO) and/or the maximum air volume exhaled in the first second (%FEV1) to that individual, transplant candidate, or the intensity of the dyspnea or the need of additional oxygen therapy in the previous 4 weeks of the intense chemotherapy regimen (pretransplant conditioning of hematopoietic cells). It is classified as a severe pulmonary disease with values of the expected percentage of DLCO or FEV1≤ 65%, or dyspnea at rest or the need of oxygen therapy, and moderate pulmonary disease with values of the expected percentage of DLCO or FEV1 between 66% and 80% or dyspnea in mild activities. The reference equation which should be used for the eventual application of this score is not currently defined. The choice of the used predicted equations, ECSC and GLI,1 is related to its wide usage in all Europe and by being the last equation recommended by the American Thoracic Society and European Respiratory Society since 2019 (although not yet used in many hospitals), respectively. In the United States, ethnically appropriate National Health and Nutrition Examination Survey (NHANES) III reference equations are recommended for those aged 8–80 years.4 We enrolled 154 patients (Table 1) and found, as expected, that there was a statistically significant association between the values of the expected percentage of FEV1 according to the ECSC equation5 and the values of the expected percentage of FEV1 according to the GLI equation,1 evaluated by the Pearson correlation coefficient as very high (r = 0.890; p < 0.001), suggesting the existence of a linear association between the results of both equations. Meanwhile, the values of the expected percentage of the FEV1, according to the ECSC equation,5 were on average higher levels (M = 97.25%; SD = 19.89), in comparison to the values of the expected percentage of the FEV1, according to the GLI equation1 (M = 92.49; SD = 15.58), statistical significance, t(149) = 6.40 (p < 0.001) (Table 2). Moreover, by applying the HCT-CI score, namely the designated criterion of presence and/or severeness of the pulmonary disease, according to the obtained values of the expected FEV1, the prevalence of patients without a pulmonary disease in our sample was of 80.5%, through the ECSC equation5 and 77.3% through the GLI equation.1 The moderate pulmonary disease obtained a prevalence of 9.1% through the ECSC equation5 and 13.6% through the GLI equation.1 Finally, the severe pulmonary disease represented 7.8% of the distribution through the ECSC equation5 and 8.4% of the distribution through the GLI equation.1 Applying the GLI equation, the frequency of lung disease is higher (in both subgroups: moderate lung disease and severe lung disease) (Table 3). Thus, our data support that the choice of the used equation might affect the obtained scoring in the designated criterion of pulmonary disease and, consequently, have an impact on the obtained HCT-CI score, and finally influence the clinical decision. The authors suggest that the laboratory should present the value of the expected percentage of the FEV1 obtained according to both equations every time it is verified that the scoring obtained will be different in the criterion of presence and/or severeness of the pulmonary disease of the HCT-CI score. This way the used equation won't influence this support tool in the clinical decision. Finally, the authors highlight the need for more study cases to determine the best equation to use in this group of patients and standardize the obtained value by the HCT-CI score. Ana Luísa Ramos, Cláudia Varandas, and Henrique Cabrita contributed to the planning, conduct, reporting, conception, design, and acquisition of data and drafting the manuscript. Claúdia Pereira and Dina Escaleira contributed to the acquisition of data. Edgar Mesquita contributed to statistical analysis of data. João Valença contributed to conduct, reporting, conception, and revision of the article. Susana Moreira contributed to planning, conduct, reporting, conception, design, acquisition of data, and revision of the article. All authors read and approved the final manuscript. The authors declare no conflicts of interest. The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Data are available on request from the authors. Data are available on request from the authors.

Source: Health Science Reports

DOI: 10.1002/hsr2.707