Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality

Pushpa M. Jairam*, Yolanda van der Graaf, Jan-Willem J. Lammers, Willem P. Th M. Mali, Pim A. de Jong,

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background This study aimed to evaluate whether incidental CT findings of emphysema, airway thickening and bronchiectasis, as seen on CT scans performed for other non-pulmonary clinical indications, are associated with future acute exacerbations of COPD resulting in hospitalisation or death.

Methods This multicentre prospective case-cohort study comprised 6406 subjects who underwent routine diagnostic chest CT for non-pulmonary indications. Using a case-cohort approach, we visually graded CT scans from cases and a random sample of similar to 10% of the baseline cohort (n=704) for emphysema severity (range 0-20), airway thickening (range 0-5) and bronchiectasis (range 0-5). We used weighted Cox proportional hazards analysis to assess the independent association between CT findings and hospitalisation or death due to COPD exacerbation.

Results During a median follow-up of 4.4 years (maximum 5.2 years), 338 COPD events were identified. The risk of experiencing a future acute exacerbation of COPD resulting in hospitalisation or death was significantly increased in subjects with severe emphysema (score >= 7) and severe airway thickening (score >= 3). The respective HRs were 4.6 (95% CI 3.0 to 7.1) and 5.9 (95% CI 3.4 to 10.5). Severe bronchiectasis (score >= 3) was not significantly associated with increased risk of adverse events (HR 1.5; 95% CI 0.9 to 2.5).

Conclusions Morphological correlates of COPD such as emphysema and airway thickening detected on CT scans obtained for other non-pulmonary indications are strong independent predictors of subsequent development of acute exacerbations of COPD resulting in hospitalisation or death.

Original languageEnglish
Pages (from-to)725-731
Number of pages7
JournalThorax
Volume70
Issue number8
DOIs
Publication statusPublished - Aug 2015

Keywords

  • OBSTRUCTIVE PULMONARY-DISEASE
  • COMPUTED-TOMOGRAPHY
  • PROGNOSTIC VALUE
  • PREVALENCE
  • RISK
  • EMPHYSEMA
  • DESIGN
  • COHORT
  • DEATH
  • SCANS

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