4.1 Article

Clinical Significance of Radiologic Characterizations in COPD

Journal

Publisher

TAYLOR & FRANCIS INC
DOI: 10.3109/15412550903341513

Keywords

BODE; Exacerbation; COPD; HRCT; HRQL

Funding

  1. National Institutes of Health Lung Tissue Research Consortium [N01 HR46158, N01 HR46160, N01 HR46161, N01 HR46162, N01HR46163, N01 HR46164, P50 HL084948, KL2 RR024987, K24 HL04212, R01 HL082480]
  2. Biomedical Laboratory Research & Development Service, Department of Veterans Affairs

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COPD is a heterogeneous disorder with clinical assessment becoming increasingly multidimensional. We hypothesized HRCT phenotype would strongly influence clinical outcomes including health status, exacerbation frequency, and BODE. COPD subjects were characterized via the SF-12, SGRQ, MMRC, physiologic testing, and standardized volumetric chest HRCT. Visual semi-quantitative estimation of bronchial wall thickness (VBT) and automated quantification of emphysema percent and bronchial wall thickness were generated. Multivariate modeling compared emphysema severity and airway abnormality with clinical outcome measures. Poisson models were used to analyze exacerbation frequency. SGRQ and SF-12 physical component scores were influenced by FEV1% predicted, emphysema percent, and VBT. VBT scores > 2 (scale 0-48) were associated with increased exacerbation frequency (p = 0.009) in the preceding year adjusting for age, gender, emphysema percent, smoking history and FEV1% predicted, although this effect was attenuated by age. Emphysema percent correlated with total BODE score in unadjusted (r = 0.73; p < 0.0001) and adjusted (p < 0.0001) analyses and with BODE individual components. HRCT provides unique COPD phenotyping information. Radiographic quantification of emphysema and bronchial thickness are independently associated with SGRO and physical component score of the SF-12. Bronchial thickness but not emphysema is associated with exacerbation frequency, whereas emphysema is a stronger predictor of BODE and its systemic components MMRC, 6MWT, and BMI. Future research should clarify whether CT parameters complement BODE score in influencing survival.

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