title: Predictors of pneumothorax following endoscopic valve therapy in patients with severe emphysema.
abstract: BACKGROUND
  Endoscopic valve implantation is an effective treatment for patients with advanced emphysema. Despite the minimally invasive procedure, valve placement is associated with risks, the most common of which is pneumothorax. This study was designed to identify predictors of pneumothorax following endoscopic valve implantation.
  
  
  METHODS
  Preinterventional clinical measures (vital capacity, forced expiratory volume in 1 second, residual volume, total lung capacity, 6-minute walk test), qualitative computed tomography (CT) parameters (fissure integrity, blebs/bulla, subpleural nodules, pleural adhesions, partial atelectasis, fibrotic bands, emphysema type) and quantitative CT parameters (volume and low attenuation volume of the target lobe and the ipsilateral untreated lobe, target air trapping, ipsilateral lobe volume/hemithorax volume, collapsibility of the target lobe and the ipsilateral untreated lobe) were retrospectively evaluated in patients who underwent endoscopic valve placement (n=129). Regression analysis was performed to compare those who developed pneumothorax following valve therapy (n=46) with those who developed target lobe volume reduction without pneumothorax (n=83).
  
  
  RESULTS
  Low attenuation volume% of ipsilateral untreated lobe (odds ratio [OR] =1.08, P=0.001), ipsilateral untreated lobe volume/hemithorax volume (OR =0.93, P=0.017), emphysema type (OR =0.26, P=0.018), pleural adhesions (OR =0.33, P=0.012) and residual volume (OR =1.58, P=0.012) were found to be significant predictors of pneumothorax. Fissure integrity (OR =1.16, P=0.075) and 6-minute walk test (OR =1.05, P=0.077) were also indicative of pneumothorax. The model including the aforementioned parameters predicted whether a patient would experience a pneumothorax 84% of the time (area under the curve =0.84).
  
  
  CONCLUSIONS
  Clinical and CT parameters provide a promising tool to effectively identify patients at high risk of pneumothorax following endoscopic valve therapy.
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research.
authors.forename: Daniela
authors.initials: D
authors.lastname: Gompelmann
authors.affiliation: Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg; Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hyun-Ju
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research.
authors.forename: Ralf
authors.initials: R
authors.lastname: Eberhardt
authors.affiliation: First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Gerovasili
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research.
authors.forename: Felix Jf
authors.initials: FJ
authors.lastname: Herth
authors.affiliation: Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg; Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.affiliation: Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg; Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Eichinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001999:Bronchoscopy / Q000009:adverse effects* / Q000295:instrumentation; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014797:Vital Capacity; D000070857:Walk Test
keywords: COPD; emphysema; endoscopic lung volume reduction; pneumothorax; valve therapy