Emphysema scores predict death from COPD and lung cancer.
OBJECTIVE
Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.


METHODS
Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came first. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death.


RESULTS
Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P < .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history.


CONCLUSIONS
Visual assessment of emphysema on CT scan is a significant predictor of death from COPD and lung cancer.
Department of Pulmonary Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Javier J
JJ
Zulueta
Divisions of General Internal Medicine and Pulmonary, Critical Care and Pulmonary Medicine, Mount Sinai School of Medicine, New York, NY.
Juan P
JP
Wisnivesky
Department of Radiology, Mount Sinai School of Medicine, New York, NY. Electronic address: Claudia.Henschke@mountsinai.org.
Claudia I
CI
Henschke
Department of Radiology, Mount Sinai School of Medicine, New York, NY.
Rowena
R
Yip
Department of Radiology, Mount Sinai School of Medicine, New York, NY.
Ali O
AO
Farooqi
Department of Radiology, Weill Cornell Medical College, New York, NY.
Dorothy I
DI
McCauley
Department of Radiology, Weill Cornell Medical College, New York, NY.
Mildred
M
Chen
Department of Medicine and Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY.
Daniel M
DM
Libby
Department of Medicine and Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY.
James P
JP
Smith
Department of Medicine and Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY.
Mark W
MW
Pasmantier
Department of Radiology, Mount Sinai School of Medicine, New York, NY.
David F
DF
Yankelevitz
D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000401:mortality*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000401:mortality*; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed