Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study - 12/02/21

Doi : 10.1016/j.rmed.2020.106245

Lee Gazourian ^a,^⁎ , William B. Thedinger ^b, Shawn M. Regis ^c, Elizabeth J. Pagura ^a, Lori Lyn Price ^d,^e, Melissa Gawlik ^f, Cristina F. Stefanescu ^g, Carla Lamb ^a, Kimberly M. Rieger-Christ ^h, Harpreet Singh ⁱ, Marcel Casasola ⁱ, Alexander R. Walker ⁱ, Arashdeep Rupal ⁱ, Avignat S. Patel ^a, Carolyn E. Come ^a, Ava M. Sanayei ^b, William P. Long ^b, Giulia S. Rizzo ^j, Andrea B. McKee ^c, George R. Washko ^k,^l, Raul San Jose Estepar ^k,^m, Christoph Wald ⁿ, Brady J. McKee ⁿ, Carey C. Thomson ^i,^o,^p,^{^{1
Co-senior authors.}}, Timothy N. Liesching ^a,^{^{1
Co-senior authors.}}
^a Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^b Tufts University School of Medicine, Boston, MA, 02111, USA
^c Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^d Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
^e Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA
^f Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^g Department of Pediatrics, Tufts Medical CenterBoston, MA, 02111, USA
^h Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
ⁱ Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
^j Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA
^k Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
^l Applied Chest Imaging Laboratories, Brigham and Women's Hospital, Boston, MA, 02115, USA
^m Department of Radiology, Brigham and Women's Hospital Boston, MA, 02115, USA
ⁿ Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^o Harvard Medical School, Boston, MA, 02115, USA
^p Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA

^∗Corresponding author.

Abstract

Background

In the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission.

Study design and Methods

We conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital (MAH) CTLS program, Cambridge, MA. CTLS exams were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission.

Results

We included 4673 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.07–1.23; p < 0.001) and COPD-related admission (HR 1.64; 95% CI 1.14–2.36; p = 0.007), but not with pneumonia-related admission (HR 1.52; 95% CI 1.27–1.83; p < 0.001). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07–3.95; p = 0.031).

Conclusion

Qualitative CT assessment of emphysema is associated with COPD-related hospital admission in a CTLS population. Identification of emphysema on CLTS exams may provide an opportunity for prevention and early intervention to reduce admission risk.

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Highlights

•	Qualitative emphysema is associated with risk for COPD hospitalization.
•	Lung cancer screening represents are an opportunity to screen for COPD.
•	Lung cancer screening represents an opportunity to improve vaccination rates.
•	Lung cancer screening represents an opportunity to improve smoking cessation rates.

Le texte complet de cet article est disponible en PDF.

Keywords : Emphysema, Lung cancer, Lung cancer screening

Plan

Qualitative emphysema

CT scans

Statistical analysis

Results

Qualitative Emphysema and All-cause hospital admission

Qualitative Emphysema and COPD admission

Qualitative Emphysema and Pneumonia admission

Quality Metrics

Discussion

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Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study - 12/02/21

Abstract

Background

Study design and Methods

Results

Conclusion

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Plan

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