Using a Low Attenuation Area Threshold on CT to Identify High-risk COPD Patients in a Multi-center Study: Opportunities for Early Intervention and Risk Reduction
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Le résumé fourni par la source
Abstract Rationale: Chronic obstructive pulmonary disease (COPD) and lung cancer are major causes of morbidity and mortality. The low attenuation area at -950 Hounsfield units (%LAA-950) on CT scans quantifies emphysema severity, with levels between 1-5% linked to higher mortality and cancer risk. However, its potential in predicting COPD-specific hospital admissions and guiding preventive measures remains understudied. This study aimed to identify a %LAA threshold corresponding to a two-fold hazard ratio (HR) for COPD hospitalizations, proposing that this could inform preventive care through accessible strategies, such as smoking cessation, vaccinations, and COPD screening. Methods: This retrospective, multi-center cohort study included patients from Lahey Hospital and Medical Center (LHMC) and Mount Auburn Hospital (MAH), eligible for CT lung screening (CTLS) per NCCN high-risk criteria. Baseline CTLS scans (2012-2017 at LHMC; 2015-2019 at MAH) were analyzed using the 4DMedical Lung Density Analysis (LDA) algorithm to generate global %LAA-950 scores. Follow-up through 2019 (LHMC) and 2020 (MAH) included assessments of mortality, lung cancer incidence, COPD hospitalizations, and clinical opportunities. Cox proportional hazards models evaluated associations between %LAA-950 thresholds and COPD admissions, adjusted for age, sex, BMI, smoking status, and pack-years (p<0.05 for significance). Results: At LHMC, 4,642 of 4,673 scans (99.3%) and, at MAH, 1,254 of 1,271 scans (98.7%) were successfully processed. The LHMC cohort had a mean age of 62.4 years (54.4% male, 94.3% white), and the MAH cohort averaged 64.3 years (49% male, 90% white). A 2% LAA threshold corresponded to a two-fold HR for COPD admissions: HR 2.03 (CI: 1.45-2.83, p < 0.001) at LHMC and HR 3.47 (CI: 1.93-6.24, p < 0.001) at MAH. Preventive care opportunities for these high-risk patients included: smoking cessation for 389 (45.0%) at LHMC and 44 (44%) at MAH; PCV13 vaccination review for 350 (41%) at LHMC and 27 (27%) at MAH; PCV23 review for 182 (21%) at LHMC and 42 (42%) at MAH; and PFT screening for 516 (60%) at LHMC and 30 (30%) at MAH. Table 1 details primary care and risk factor modification opportunities. Conclusion: The 2% LAA threshold is an effective marker for identifying patients at high risk of COPD admissions, presenting significant opportunities for preventive interventions. By incorporating this threshold into lung cancer screening, providers can target high-risk individuals for interventions that could reduce hospitalizations, healthcare costs, and disease burden. This study supports the 2% LAA threshold as a practical tool for early identification and management of at-risk patients.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Using a Low Attenuation Area Threshold on CT to Identify High-risk COPD Patients in a Multi-center Study: Opportunities for Early Intervention and Risk Reduction
- Date Crossref
- 01/05/2025
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Lahey Hospital and Medical Center Pulmonary and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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Lahey Medical Center pays non établi dans la noticeÉtablissement de santé
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Mount Auburn Hospital Medicine pays non établi dans la noticeÉtablissement de santé
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St. Elizabeth's Medical Center Pulmonary Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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Thomas Jefferson University Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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University of Miami Oncology pays non établi dans la noticeUniversité ou école supérieure
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University of South Florida Pulmonary Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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West Virginia University Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Eastern Maine Medical Center Pulmonary and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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SUNY Upstate Medical University Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Massachusetts General Hospital Radiology pays non établi dans la noticeÉtablissement de santé
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University of California pays non établi dans la noticeUniversité ou école supérieure
Pulmonary and Critical Care Medicine — Lahey Hospital and Medical Center, Lahey Medical Center et Medicine — Mount Auburn Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.