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Obvious emphysema on CT during an acute exacerbation of COPD predicts a poor prognosis.
Intern Med J. 2015 Feb 13;
Authors: Cheng T, Wan H, Cheng Q, Guo Y, Qian Y, Fan L, Feng Y, Song Y, Zhou M, Li Q, Shi G, Huang S
Abstract
BACKGROUND: Emphysematous change on computed tomography (CT) during the stable phase of chronic obstructive pulmonary disease (COPD) is reported to correlate with COPD prognosis. Acute exacerbation of COPD (AECOPD) is associated with a high risk of mortality and a poor prognosis.
AIMS: To study the relationship between prognosis and emphysematous changes on CT during an AECOPD.
METHODS: Histories were recorded and CT acquired for 106 patients who visited the emergency department for an AECOPD. Emphysematous change was quantified by measuring the percentage of low-attenuation areas (LAA%) in the entire lung on CT images with a threshold of -950 HU. Other factors that could influence AECOPD prognosis were also recorded upon admission and analysed. At follow-ups conducted in 1 year, patient survival, the modified Medical Research Council (mMRC) Dyspnea Scale, and performance status (PS) were evaluated, and a COPD Assessment Test (CAT) was completed.
RESULTS: The 1-year follow-up was completed by 103 of 106 patients. The median LAA% was significantly higher in non-survivors (11%, n=16) than in survivors (5.69%, n=87) (p=0.006) at the 1-year follow-up. LAA% was significantly correlated with mMRC grade (r=0.285, p=0.008), PS (r=0.397, p<0.001), and CAT score (r=0.27, p=0.017) at the 3-month follow-up, and with mMRC grade (r=0.405, p<0.001) and PS (r=0.377, p<0.001) at the 1-year follow-up. LAA%>7.5% was a significant predictor of 1-year mortality, higher mMRC, and PS at the 3-month and 1-year follow-ups, after adjustment for other prognostic predictors.
CONCLUSIONS: Obvious emphysematous changes on CT (LAA%>7.5%) during an AECOPD predicts a poor prognosis independent of other known indicators.
PMID: 25684314 [PubMed - as supplied by publisher]