{"doi":"10.1111/resp.14336","title":"Breath‐holding physiology, radiological severity and adverse outcomes in <scp>COVID</scp>‐19 patients: A prospective validation study","abstract":"BACKGROUND AND OBJECTIVE: COVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement. METHODS: Hospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'. RESULTS: Elevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]). CONCLUSION: An elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.","journal":"Respirology","year":2022,"id":295644,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9636,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":747993,"name":"Francesco Fanfulla","orcid":"0000-0002-8601-423X","position":1,"is_corresponding":false},{"id":748849,"name":"Leonardo Pedroni","orcid":null,"position":2,"is_corresponding":false},{"id":981917,"name":"Floriana Pini","orcid":null,"position":3,"is_corresponding":false},{"id":981544,"name":"Andrea Borghesi","orcid":"0000-0002-4761-2923","position":4,"is_corresponding":false},{"id":981918,"name":"Salvatore Golemi","orcid":null,"position":5,"is_corresponding":false},{"id":748850,"name":"Guido Vailati","orcid":null,"position":6,"is_corresponding":false},{"id":846967,"name":"Kayla Kerlin","orcid":null,"position":7,"is_corresponding":false},{"id":270458,"name":"Atul Malhotra","orcid":"0000-0002-9509-1827","position":8,"is_corresponding":false},{"id":748848,"name":"Luciano Corda","orcid":null,"position":9,"is_corresponding":false},{"id":245147,"name":"Scott A. Sands","orcid":"0000-0003-3752-0328","position":10,"is_corresponding":false},{"id":267369,"name":"Ludovico Messineo","orcid":"0000-0002-4142-9124","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T00:31:08.861377Z","pmid":"35933689","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}