Lee Gazourian1, William B Thedinger2, Shawn M Regis3, Elizabeth J Pagura4, Lori Lyn Price5, Melissa Gawlik6, Cristina F Stefanescu7, Carla Lamb4, Kimberly M Rieger-Christ8, Harpreet Singh9, Marcel Casasola9, Alexander R Walker9, Arashdeep Rupal9, Avignat S Patel4, Carolyn E Come4, Ava M Sanayei2, William P Long2, Giulia S Rizzo10, Andrea B McKee3, George R Washko11, Raul San Jose Estepar12, Christoph Wald13, Brady J McKee13, Carey C Thomson14, Timothy N Liesching4. 1. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. Electronic address: Lee.Gazourian@lahey.org. 2. Tufts University School of Medicine, Boston, MA, 02111, USA. 3. Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. 4. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. 5. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA. 6. Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. 7. Department of Pediatrics, Tufts Medical CenterBoston, MA, 02111, USA. 8. Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. 9. Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA. 10. Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA. 11. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Applied Chest Imaging Laboratories, Brigham and Women's Hospital, Boston, MA, 02115, USA. 12. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Radiology, Brigham and Women's Hospital Boston, MA, 02115, USA. 13. Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. 14. Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA; Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA.
Abstract
BACKGROUND: In the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission. STUDY DESIGN AND METHODS: We conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital (MAH) CTLS program, Cambridge, MA. CTLS exams were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission. RESULTS: We included 4673 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.07-1.23; p < 0.001) and COPD-related admission (HR 1.64; 95% CI 1.14-2.36; p = 0.007), but not with pneumonia-related admission (HR 1.52; 95% CI 1.27-1.83; p < 0.001). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07-3.95; p = 0.031). CONCLUSION: Qualitative CT assessment of emphysema is associated with COPD-related hospital admission in a CTLS population. Identification of emphysema on CLTS exams may provide an opportunity for prevention and early intervention to reduce admission risk.
BACKGROUND: In the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission. STUDY DESIGN AND METHODS: We conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital (MAH) CTLS program, Cambridge, MA. CTLS exams were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission. RESULTS: We included 4673 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.07-1.23; p < 0.001) and COPD-related admission (HR 1.64; 95% CI 1.14-2.36; p = 0.007), but not with pneumonia-related admission (HR 1.52; 95% CI 1.27-1.83; p < 0.001). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07-3.95; p = 0.031). CONCLUSION: Qualitative CT assessment of emphysema is associated with COPD-related hospital admission in a CTLS population. Identification of emphysema on CLTS exams may provide an opportunity for prevention and early intervention to reduce admission risk.
Authors: Amir Qaseem; Timothy J Wilt; Steven E Weinberger; Nicola A Hanania; Gerard Criner; Thys van der Molen; Darcy D Marciniuk; Tom Denberg; Holger Schünemann; Wisia Wedzicha; Roderick MacDonald; Paul Shekelle Journal: Ann Intern Med Date: 2011-08-02 Impact factor: 25.391
Authors: Andrea K Borondy Kitts; Andrea B McKee; Shawn M Regis; Christoph Wald; Sebastian Flacke; Brady J McKee Journal: J Thorac Dis Date: 2016-07 Impact factor: 2.895
Authors: Lee Gazourian; Shawn M Regis; Elizabeth J Pagura; Lori Lyn Price; Melissa Gawlik; Carla Lamb; Kimberly M Rieger-Christ; William B Thedinger; Ava M Sanayei; William P Long; Cristina F Stefanescu; Giulia S Rizzo; Avignat S Patel; Carolyn E Come; Carey C Thomson; Victor Pinto-Plata; Katrina Steiling; Andrea B McKee; Christoph Wald; Brady J McKee; Timothy N Liesching Journal: Respir Med Date: 2021-07-12 Impact factor: 4.582