Chest Computed Tomography Predicts the Frequency of Pulmonary Exacerbations in Children with Cystic Fibrosis

Rationale: Abnormalities on chest computed tomography (CT) in children with cystic fibrosis (CF) have been shown to correlate with short-term measures of lung disease. Chest CT scores offer promise as a potential surrogate end point in CF; however, there is limited information available on the ability of chest CT scores to predict future morbidity. Objectives: Determine whether chest CT scores are associated with the rate of pulmonary exacerbations over the next 10 years. Methods: Ten years of follow-up data were obtained from the CF Foundation Patient Registry for 60 children enrolled in the Pulmozyme Early Intervention Trial and who had chest CT scans at baseline. Measurements and Main Results: Multivariable Poisson regression was used to compare Brody CT scores and the number of pulmonary exacerbations in the following 10 years. At the time of the chest CT, the mean (SD) age was 10.6 (1.7) years. A 1-point increase in the Brody CT score was associated with an increase in the mean (95% confidence interval) rate of pulmonary exacerbations of 1.39 (1.15, 1.67) (P < 0.001). Brody CT scores were more strongly associated with the number of pulmonary exacerbations than FENT I % predicted at the time of the chest CT (P = 0.037 by chi-square test). Conclusions: There is a significant association between Brody CT scores and the rate of pulmonary exacerbations up to 10 years later. This association is stronger than for FEVI obtained at the time of the CT, suggesting that chest CT scores offer improved ability to predict future outcomes.