Relationship between emphysema progression at CT and mortality in ever-smokers: results from the COPDGene and ECLIPSE cohorts
Radiology, 2021•pubs.rsna.org
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) …
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) …
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 ± 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years ± 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 ± 0.6 in COPDGene and 3.0 years ± 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.
© RSNA, 2021
See also the editorial by Lee and Park in this issue.
Radiological Society of North America