Chest
Volume 138, Issue 3, September 2010, Pages 635-640
Journal home page for Chest

Original Research
COPD
CT Scan Findings of Emphysema Predict Mortality in COPD

https://doi.org/10.1378/chest.09-2836Get rights and content

Background

Emphysematous change as assessed by CT imaging has been reported to correlate with COPD prognostic factors such as FEV1 and diffusing capacity of the lung for carbon monoxide (Dlco). However, few studies have assessed the relationship between CT scan assessment and COPD mortality from mild to severe stages of the disease. In this study, we analyzed this relationship in patients with various stages of COPD.

Methods

Two hundred and fifty-one outpatients with stable COPD were included in the study. CT scan and pulmonary function tests were performed at study entry in a single institution. The percentage of low attenuation area was measured to quantitatively evaluate emphysematous change with a custom-made software. Prognostic data also were collected, and the median follow-up time was 8 years.

Results

Of the 251 patients, 79 died, with 40 classified as respiratory deaths not involving lung cancer. Univariate Cox analysis revealed that emphysematous change as assessed by CT scan, lung function, age, or BMI were significantly correlated with mortality. Multivariate analysis revealed that emphysematous change as assessed by CT scan had the best association with mortality.

Conclusions

Emphysematous change as assessed by CT scan predicts respiratory mortality in outpatients with various stages of COPD.

Section snippets

Subjects and Study Design

This study is part of an ongoing COPD follow-up study being performed at Kyoto University (Kyoto, Japan). From regularly treated outpatients with COPD, 251 were enrolled who had CT scans performed at Kyoto University Hospital between April 1995 and April 2005, and their vital statuses as of April 2009 were ascertained. Hospital records were examined to determine the cause of any deaths. When contact with patients was lost, we contacted them or their families by telephone. All deaths were

Baseline Characteristics

Table 1 shows the subjects' baseline characteristics. The number of patients with COPD in each GOLD stage1 was as follows: stage I, 14; stage II, 111; stage III, 90; and stage IV, 36. Because of poor lung function, three subjects did not bear the diffusion capacity test.

Prognostic Research

The median follow-up time as of April 2009 was 2,933 days (range, 215–5,107 days). At the time of analysis, it was not possible to ascertain the vital statuses of 10 of the 251 subjects because they had moved away and could not

Discussion

This study demonstrated that emphysema as assessed by CT imaging is a good predictor of mortality in patients with COPD with various stages of the disease. We documented that increased mortality was independently associated with increased age, higher LAA%, lower BMI, lower FEV1, higher RV/TLC, and lower Dlco/Va. Multivariate analyses indicated that a higher LAA% was associated with mortality independently of increased age, lower BMI, lower FEV1, and lower Dlco/Va. Thus, the extent of emphysema

Conclusions

In conclusion, the extent of emphysema, as assessed by CT scan, is a good predictor of mortality in patients with COPD. This study suggests that CT imaging is a useful tool not only for detecting emphysema but also for predicting mortality in patients with COPD.

References (34)

  • BR Celli et al.

    The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease

    N Engl J Med

    (2004)
  • T Ringbaek et al.

    Standardised mortality rates in females and males with COPD and asthma

    Eur Respir J

    (2005)
  • NR Anthonisen et al.

    The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial

    Ann Intern Med

    (2005)
  • DO Wilson et al.

    Body weight in chronic obstructive pulmonary disease

    Am Rev Respir Dis

    (1989)
  • C Landbo et al.

    Prognostic value of nutritional status in chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1999)
  • VM Pinto-Plata et al.

    The 6-min walk distance: change over time and value as a predictor of survival in severe COPD

    Eur Respir J

    (2004)
  • Y Nakano et al.

    Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function

    Am J Respir Crit Care Med

    (2000)
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    Funding/Support: This study was partially supported by a Grant-in-Aid for scientific research (B) [No. 16390234] and (C) [No. 21590964].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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