Clinical significance of radiologic characterizations in COPD.
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 FEV(1)% 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 FEV(1)% 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 SGRQ 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.
Han
MeiLan K
MK
University of Michigan Health System, Ann Arbor, Michigan 48109-5360, USA. mrking@umich.edu
Bartholmai
Brian
B
Liu
Lyrica X
LX
Murray
Susan
S
Curtis
Jeffrey L
JL
Sciurba
Frank C
FC
Kazerooni
Ella A
EA
Thompson
Bruce
B
Frederick
Margaret
M
Li
Daner
D
Schwarz
Marvin
M
Limper
Andrew
A
Freeman
Christine
C
Landreneau
Rodney J
RJ
Wise
Robert
R
Martinez
Fernando J
FJ
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000235:genetics / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000235:genetics / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*