Imaani Easthausen1,2, Anna Podolanczuk2, Eric Hoffman3, Steven Kawut4, Elizabeth Oelsner2, John S Kim5, Ganesh Raghu6, Karen Hinckley Stukovsky7, Susan Redline8, Robyn L McClelland7, R Graham Barr2,9, David J Lederer2,10. 1. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. 2. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. 4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Medicine, University of Virginia, Charlottesville, VA, USA. 6. Department of Medicine, University of Washington, Seattle, WA, USA. 7. Department of Biostatistics, University of Washington, Seattle, WA, USA. 8. Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA. 9. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. 10. Regeneron Pharmaceuticals, New York, NY, USA.
Abstract
BACKGROUND AND OBJECTIVE: Normative values for HAA-a quantitative, CT-based measure of subclinical ILD-in healthy adults are needed to improve interpretability in clinical and research settings. METHODS: HAA was measured on full-lung CT in 3110 participants in the MESA study. Clinical prediction models were developed using a healthy never-smoker subset with normal spirometry (n = 696). RMSE on cross-validation was used as the primary criterion for model selection. Parametric and non-parametric methods were considered. z-Scores were calculated for the entire study sample. Associations between z-scores and several ILD features were estimated. RESULTS: In the healthy never-smoker subset, the mean age was 69 years with a range of 54-93 years. The median HAA was 4.3% with a range of 2.7-17.8%. Linear regression had better predictive performance than other methods. The final model included race, height, weight, age and sex. The standard error of the estimate was 1.62 with a cross-validated RMSE of 1.64 and an adjusted R2 of 0.139. z-Scores were associated with several ILD outcomes in adjusted models, including ILA (OR: 1.40 per z-unit; 95% CI: 1.30, 1.52), exertional dyspnoea (OR: 1.08 per z-unit; 95% CI: 1.02, 1.15) and FVC (expected increase per z-unit: -2.49; 95% CI: -2.95, - 2.03). CONCLUSION: We present a reference equation and z-scores to define expected values of HAA on full-lung CT to aid HAA interpretation in middle-aged and older adults.
BACKGROUND AND OBJECTIVE: Normative values for HAA-a quantitative, CT-based measure of subclinical ILD-in healthy adults are needed to improve interpretability in clinical and research settings. METHODS: HAA was measured on full-lung CT in 3110 participants in the MESA study. Clinical prediction models were developed using a healthy never-smoker subset with normal spirometry (n = 696). RMSE on cross-validation was used as the primary criterion for model selection. Parametric and non-parametric methods were considered. z-Scores were calculated for the entire study sample. Associations between z-scores and several ILD features were estimated. RESULTS: In the healthy never-smoker subset, the mean age was 69 years with a range of 54-93 years. The median HAA was 4.3% with a range of 2.7-17.8%. Linear regression had better predictive performance than other methods. The final model included race, height, weight, age and sex. The standard error of the estimate was 1.62 with a cross-validated RMSE of 1.64 and an adjusted R2 of 0.139. z-Scores were associated with several ILD outcomes in adjusted models, including ILA (OR: 1.40 per z-unit; 95% CI: 1.30, 1.52), exertional dyspnoea (OR: 1.08 per z-unit; 95% CI: 1.02, 1.15) and FVC (expected increase per z-unit: -2.49; 95% CI: -2.95, - 2.03). CONCLUSION: We present a reference equation and z-scores to define expected values of HAA on full-lung CT to aid HAA interpretation in middle-aged and older adults.
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