Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study,Respiratory Medicine

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Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study
Respiratory Medicine ( IF 3.5 ) Pub Date : 2020-11-20 , DOI: 10.1016/j.rmed.2020.106245
Lee Gazourian ₁ , William B Thedinger ₂ , Shawn M Regis ₃ , Elizabeth J Pagura ₁ , Lori Lyn Price ₄ , Melissa Gawlik ₅ , Cristina F Stefanescu ₆ , Carla Lamb ₁ , Kimberly M Rieger-Christ ₇ , Harpreet Singh ₈ , Marcel Casasola ₈ , Alexander R Walker ₈ , Arashdeep Rupal ₈ , Avignat S Patel ₁ , Carolyn E Come ₁ , Ava M Sanayei ₂ , William P Long ₂ , Giulia S Rizzo ₉ , Andrea B McKee ₃ , George R Washko ₁₀ , Raul San Jose Estepar ₁₁ , Christoph Wald ₁₂ , Brady J McKee ₁₂ , Carey C Thomson ₁₃ , Timothy N Liesching ₁

Affiliation

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Tufts University School of Medicine, Boston, MA, 02111, USA.
Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA.
Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Department of Pediatrics, Tufts Medical CenterBoston, MA, 02111, USA.
Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA.
Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Applied Chest Imaging Laboratories, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Radiology, Brigham and Women's Hospital Boston, MA, 02115, USA.
Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA; Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA.

Background

In the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission.

Study design

and Methods: We conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital CTLS program (MAH), Cambridge, MA. CT scans were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission.

Results

We included 4675 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.03–1.31; p = 0.014) and COPD-related admission (HR 1.64; 95% CI 1.14–2.36; p = 0.007), but not with pneumonia-related admission (HR 1.33; 95% CI 0.96–1.85; p = 0.088). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07–3.95; p = 0.031).

Conclusion

Qualitative CT assessment of emphysema is associated with COPD-related hospital admission. Identification of CT emphysema may provide an opportunity for prevention and early intervention to reduce admission risk.

中文翻译：

一项多中心 CT 肺癌筛查队列研究中的定性肺气肿和 COPD 住院风险

背景

在美国，估计有 9 到 1000 万美国人有资格进行计算机断层扫描肺癌筛查 (CTLS)。那些符合 CTLS 标准的人有许多心肺合并症的高风险。本研究的目的是确定在筛查 CT 中发现的定性肺气肿与住院风险之间的关联。

学习规划

和方法：我们对两个 CTLS 队列进行了一项回顾性多中心研究：Lahey 医院和医疗中心 (LHMC) CTLS 计划，马萨诸塞州伯灵顿和奥本山医院 CTLS 计划 (MAH)，马萨诸塞州剑桥。在筛查肺气肿存在时，放射科医师对 CT 扫描进行定性评分。多变量 Cox 回归模型用于评估 CT 定性肺气肿与全因、COPD 相关和肺炎相关住院之间的关联。

结果

我们包括来自 LHMC 队列的 4675 名参与者和来自 MAH 队列的 915 名参与者。LHMC 和 MAH 队列中分别有 57% 和 51.9% 存在 CT 肺气肿。在 LHMC 队列中，肺气肿的存在与全因住院（HR 1.15，CI 1.03–1.31；p = 0.014）和 COPD 相关入院（HR 1.64；95% CI 1.14–2.36；p = 0.007）相关，但与肺炎相关的入院无关（HR 1.33；95% CI 0.96–1.85；p = 0.088）。在 MAH 队列中，肺气肿的存在仅与 COPD 相关入院有关（HR 2.05；95% CI 1.07–3.95；p = 0.031）。