TY - JOUR
T1 - Relationship between Emphysema Progression at CT and Mortality in Ever-Smokers
T2 - Results from the COPDGene and ECLIPSE Cohorts
AU - Ash, Samuel Y.
AU - Estépar, Raúl San José
AU - Fain, Sean B.
AU - Tal-Singer, Ruth
AU - Stockley, Robert A.
AU - Nordenmark, Lars H.
AU - Rennard, Stephen
AU - Han, Mei Lan K.
AU - Merrill, Debora
AU - Humphries, Stephen M.
AU - Diaz, Alejandro A.
AU - Mason, Stefanie E.
AU - Rahaghi, Farbod N.
AU - Pistenmaa, Carrie L.
AU - Sciurba, Frank C.
AU - Vegas-Sánchez-Ferrero, Gonzalo
AU - Lynch, David A.
AU - Washko, George R.
N1 - Publisher Copyright:
© RSNA, 2021
PY - 2021/4
Y1 - 2021/4
N2 - Background: The relationship between emphysema progression and long-term outcomes is unclear. Purpose: To determine the relationship between emphysema progression at CT and mortality among participants with emphysema. Materials and Methods: In a secondary analysis of two prospective observational studies, COPDGene (clinicaltrials.gov, NCT00608764) and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE; clinicaltrials.gov, NCT00292552), emphysema was measured at CT at two points by using the volume-adjusted lung density at the 15th percentile of the lung density histogram (hereafter, lung density perc15) method. The association between emphysema progression rate and all-cause mortality was analyzed by using Cox regression adjusted for ethnicity, sex, baseline age, pack-years, and lung density, baseline and change in smoking status, forced expiratory volume in 1 second, and 6-minute walk distance. In COPDGene, respiratory mortality was analyzed by using the Fine and Gray method. Results: A total of 5143 participants (2613 men [51%]; mean age, 60 years 6 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years 6 8) in ECLIPSE were evaluated, of which 2097 (40.8%) and 1179 (76.1%) had emphysema, respectively. Baseline imaging was performed between January 2008 and December 2010 for COPDGene and January 2006 and August 2007 for ECLIPSE. Follow-up imaging was performed after 5.5 years 6 0.6 in COPDGene and 3.0 years 6 0.2 in ECLIPSE, and mortality was assessed over the ensuing 5 years in both. For every 1 g/L per year faster rate of decline in lung density perc15, all-cause mortality increased by 8% in COPDGene (hazard ratio [HR], 1.08; 95% CI: 1.01, 1.16; P = .03) and 6% in ECLIPSE (HR, 1.06; 95% CI: 1.00, 1.13; P = .045). In COPDGene, respiratory mortality increased by 22% (HR, 1.22; 95% CI: 1.13, 1.31; P , .001) for the same increase in the rate of change in lung density perc15. Conclusion: In ever-smokers with emphysema, emphysema progression at CT was associated with increased all-cause and respiratory mortality.
AB - Background: The relationship between emphysema progression and long-term outcomes is unclear. Purpose: To determine the relationship between emphysema progression at CT and mortality among participants with emphysema. Materials and Methods: In a secondary analysis of two prospective observational studies, COPDGene (clinicaltrials.gov, NCT00608764) and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE; clinicaltrials.gov, NCT00292552), emphysema was measured at CT at two points by using the volume-adjusted lung density at the 15th percentile of the lung density histogram (hereafter, lung density perc15) method. The association between emphysema progression rate and all-cause mortality was analyzed by using Cox regression adjusted for ethnicity, sex, baseline age, pack-years, and lung density, baseline and change in smoking status, forced expiratory volume in 1 second, and 6-minute walk distance. In COPDGene, respiratory mortality was analyzed by using the Fine and Gray method. Results: A total of 5143 participants (2613 men [51%]; mean age, 60 years 6 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years 6 8) in ECLIPSE were evaluated, of which 2097 (40.8%) and 1179 (76.1%) had emphysema, respectively. Baseline imaging was performed between January 2008 and December 2010 for COPDGene and January 2006 and August 2007 for ECLIPSE. Follow-up imaging was performed after 5.5 years 6 0.6 in COPDGene and 3.0 years 6 0.2 in ECLIPSE, and mortality was assessed over the ensuing 5 years in both. For every 1 g/L per year faster rate of decline in lung density perc15, all-cause mortality increased by 8% in COPDGene (hazard ratio [HR], 1.08; 95% CI: 1.01, 1.16; P = .03) and 6% in ECLIPSE (HR, 1.06; 95% CI: 1.00, 1.13; P = .045). In COPDGene, respiratory mortality increased by 22% (HR, 1.22; 95% CI: 1.13, 1.31; P , .001) for the same increase in the rate of change in lung density perc15. Conclusion: In ever-smokers with emphysema, emphysema progression at CT was associated with increased all-cause and respiratory mortality.
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U2 - 10.1148/RADIOL.2021203531
DO - 10.1148/RADIOL.2021203531
M3 - Article
C2 - 33591891
AN - SCOPUS:85103473682
SN - 0033-8419
VL - 299
SP - 222
EP - 231
JO - Radiology
JF - Radiology
IS - 1
ER -