A Combined Pulmonary Function and Emphysema Score Prognostic Index for Staging in Chronic Obstructive Pulmonary Disease

被引:14
作者
Boutou, Afroditi K. [1 ,2 ]
Nair, Arjun [1 ,2 ]
Douraghi-Zadeh, Dariush [3 ]
Sandhu, Ranbir [4 ]
Hansell, David M. [1 ,2 ]
Wells, Athol U. [1 ,2 ]
Polkey, Michael I. [1 ,2 ]
Hopkinson, Nicholas S. [1 ,2 ]
机构
[1] Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England
[2] Univ London Imperial Coll Sci Technol & Med, London, England
[3] Chelsea & Westminster NHS Fdn Trust, Dept Radiol, London, England
[4] Imperial Coll Healthcare NHS Trust, Dept Radiol, London, England
来源
PLOS ONE | 2014年 / 9卷 / 10期
关键词
COMPUTED-TOMOGRAPHY; PREDICT MORTALITY; CO-MORBIDITY; LUNG; CT; ARTERIAL; SURVIVAL; HYPERTENSION;
D O I
10.1371/journal.pone.0111109
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by high morbidity and mortality. Lung computed tomography parameters, individually or as part of a composite index, may provide more prognostic information than pulmonary function tests alone. Aim: To investigate the prognostic value of emphysema score and pulmonary artery measurements compared with lung function parameters in COPD and construct a prognostic index using a contingent staging approach. Material-Methods: Predictors of mortality were assessed in COPD outpatients whose lung computed tomography, spirometry, lung volumes and gas transfer data were collected prospectively in a clinical database. Univariate and multivariate Cox proportional hazard analysis models with bootstrap techniques were used. Results: 169 patients were included (59.8% male, 61.1 years old; Forced Expiratory Volume in 1 second % predicted: 40.5 +/- 19.2). 20.1% died; mean survival was 115.4 months. Age (HR = 1.098, 95% Cl = 1.04-1.252) and emphysema score (HR = 1.034, 95% CI = 1.007-1.07) were the only independent predictors of mortality. Pulmonary artery dimensions were not associated with survival. An emphysema score of 55% was chosen as the optimal threshold and 30% and 65% as suboptimals. Where emphysema score was between 30% and 65% (intermediate risk) the optimal lung volume threshold, a functional residual capacity of 210% predicted, was applied. This contingent staging approach separated patients with an intermediate risk based on emphysema score alone into high risk (Functional Residual Capacity >= 210% predicted) or low risk (Functional Residual Capacity <210% predicted). This approach was more discriminatory for survival (HR = 3.123; 95% CI = 1.094-10.412) than either individual component alone. Conclusion: Although to an extent limited by the small sample size, this preliminary study indicates that the composite Emphysema score-Functional Residual Capacity index might provide a better separation of high and low risk patients with COPD, than other individual predictors alone.
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页数:10
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