Pulmonary Arterial Enlargement and Acute Exacerbations of COPD

被引:381
作者
Wells, J. Michael [1 ]
Washko, George R. [4 ]
Han, MeiLan K. [6 ]
Abbas, Naseer [1 ]
Nath, Hrudaya [2 ]
Mamary, A. James [8 ]
Regan, Elizabeth [9 ]
Bailey, William C. [1 ]
Martinez, Fernando J. [6 ]
Westfall, Elizabeth [1 ]
Beaty, Terri H. [12 ]
Curran-Everett, Douglas [10 ]
Curtis, Jeffrey L. [6 ,7 ]
Hokanson, John E. [11 ]
Lynch, David A. [9 ]
Make, Barry J. [9 ]
Crapo, James D. [9 ]
Silverman, Edwin K. [4 ,5 ]
Bowler, Russell P. [9 ]
Dransfield, Mark T. [1 ,3 ]
机构
[1] Univ Alabama Birmingham, Lung Hlth Ctr, Div Pulm Allergy & Crit Care, Birmingham, AL 35294 USA
[2] Univ Alabama Birmingham, Dept Radiol, Birmingham, AL 35294 USA
[3] Birmingham Vet Affairs Med Ctr, Birmingham, AL USA
[4] Brigham & Womens Hosp, Div Pulm & Crit Care, Boston, MA 02115 USA
[5] Brigham & Womens Hosp, Channing Lab, Div Network Med, Boston, MA 02115 USA
[6] Univ Michigan Hlth Syst, Div Pulm & Crit Care Med, Ann Arbor, MI USA
[7] Vet Affairs Hlth Syst, Med Serv, Pulm & Crit Care Med Sect, Ann Arbor, MI USA
[8] Temple Univ, Sch Med, Div Pulm & Crit Care, Philadelphia, PA 19122 USA
[9] Natl Jewish Hlth, Div Pulm & Crit Care, Denver, CO USA
[10] Natl Jewish Hlth, Div Biostat & Bioinformat, Denver, CO USA
[11] Univ Colorado, Colorado Sch Publ Hlth, Dept Epidemiol, Aurora, CO USA
[12] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
关键词
DISEASE; HYPERTENSION; EMPHYSEMA; EPIDEMIOLOGY; PREVALENCE; PREVENTION; PHENOTYPE; PERFUSION; SMOKERS; DEATH;
D O I
10.1056/NEJMoa1203830
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. METHODS We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA: A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. RESULTS Multivariate logistic-regression analysis showed a significant association between a PA: A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P<0.001). A PA: A ratio of more than 1 was also independently associated with an increased risk of future severe exacerbations in both the trial cohort (odds ratio, 3.44; 95% CI, 2.78 to 4.25; P<0.001) and the external validation cohort (odds ratio, 2.80; 95% CI, 2.11 to 3.71; P<0.001). In both cohorts, among all the variables analyzed, a PA: A ratio of more than 1 had the strongest association with severe exacerbations. CONCLUSIONS Pulmonary artery enlargement (a PA: A ratio of > 1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.)
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收藏
页码:913 / 921
页数:9
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