Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort,Respiratory Medicine

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Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort
Respiratory Medicine ( IF 4.3 ) Pub Date : 2021-07-12 , DOI: 10.1016/j.rmed.2021.106540
Lee Gazourian ₁ , Shawn M Regis ₂ , Elizabeth J Pagura ₃ , Lori Lyn Price ₄ , Melissa Gawlik ₅ , Carla Lamb ₁ , Kimberly M Rieger-Christ ₆ , William B Thedinger ₇ , Ava M Sanayei ₇ , William P Long ₇ , Cristina F Stefanescu ₈ , Giulia S Rizzo ₉ , Avignat S Patel ₁ , Carolyn E Come ₁ , Carey C Thomson ₁₀ , Victor Pinto-Plata ₁₁ , Katrina Steiling ₁₂ , Andrea B McKee ₂ , Christoph Wald ₁₃ , Brady J McKee ₁₃ , Timothy N Liesching ₁

Affiliation

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Department of Medicine, Division of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
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.
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.
Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
Tufts University School of Medicine, Boston, MA, 02111, USA.
Department of Pediatrics, Tufts Medical Center, Boston, MA, 02111, USA.
Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA; Harvard Medical School, Boston, MA, 02115, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA, 01199, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.
Department of Hospital Based Specialties, Division of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.

Background

Patients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. We sought to examine if qualitatively assessed coronary artery calcifications (CAC) on CTLS exams could identify patients at increased risk for non-cardiovascular events such as all cause, COPD and pneumonia related hospitalization and to verify previously reported associations between CAC and mortality and cardiovascular events.

Study design and methods

Patients (n = 4673) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2017 were included with clinical follow-up through September 30, 2019. CTLS exams were qualitatively scored for the presence and severity of CAC at the time of exam interpretation using a four point scale: none, mild, moderate, and marked. Multivariable Cox regression models were used to evaluate the association between CT qualitative CAC and all-cause, COPD-related, and pneumonia-related hospital admissions.

Results

3631 (78%) of individuals undergoing CTLS had some degree of CAC on their baseline exam: 1308 (28.0%), 1128 (24.1%), and 1195 (25.6%) had mild, moderate and marked coronary calcification, respectively. Marked CAC was associated with all-cause hospital admission and pneumonia related admissions HR 1.48; 95% CI 1.23–1.78 and HR 2.19; 95% 1.30–3.71, respectively. Mild, moderate and marked CAC were associated with COPD-related admission HR 2.30; 95% CI 1.31–4.03, HR 2.17; 95% CI 1.20–3.91 and HR 2.27; 95% CI 1.24–4.15.

Conclusion

Qualitative CAC on CTLS exams identifies individuals at elevated risk for all cause, pneumonia and COPD-related hospital admissions.

中文翻译：

大型 CT 肺癌筛查队列中的定性冠状动脉钙化评分和全因、COPD 和肺炎住院风险

背景

肺癌高危患者和有资格进行 CT 肺癌筛查 (CTLS) 的患者存在多种心肺合并症的风险。我们试图检查在 CTLS 检查中定性评估的冠状动脉钙化 (CAC) 是否可以识别非心血管事件风险增加的患者，例如全因、COPD 和肺炎相关住院，并验证先前报道的 CAC 与死亡率和心血管事件之间的关联.

研究设计和方法

2012 年 1 月 12 日至 2017 年 9 月 30 日期间接受 CTLS 的来自 Lahey 医院和医疗中心的患者（n = 4673）被纳入临床随访至 2019 年 9 月 30 日。CTLS 检查对 CAC 的存在和严重程度进行定性评分在考试解释时使用四点量表：无、轻度、中度和标记。多变量 Cox 回归模型用于评估 CT 定性 CAC 与全因、COPD 相关和肺炎相关住院之间的关联。

结果

接受 CTLS 的 3631 人（78%）在基线检查中有一定程度的 CAC：1308 人（28.0%）、1128 人（24.1%）和 1195 人（25.6%）分别有轻度、中度和明显的冠状动脉钙化。标记 CAC 与全因住院和肺炎相关入院 HR 1.48 相关；95% CI 1.23–1.78 和 HR 2.19；95% 分别为 1.30–3.71。轻度、中度和显着 CAC 与 COPD 相关入院 HR 2.30 相关；95% CI 1.31–4.03，HR 2.17；95% CI 1.20–3.91 和 HR 2.27；95% CI 1.24–4.15。