Predicting severe chronic obstructive pulmonary disease exacerbations using quantitative CT: a retrospective model development and external validation study.

Autor:	Chaudhary MFA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA., Hoffman EA; Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA., Guo J; Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA., Comellas AP; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA., Newell JD Jr; Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA., Nagpal P; Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Fortis S; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA., Christensen GE; Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA., Gerard SE; Department of Radiology, University of Iowa, Iowa City, IA, USA., Pan Y; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA., Wang D; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA., Abtin F; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Barjaktarevic IZ; Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Barr RG; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA., Bhatt SP; UAB Lung Imaging Lab, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA., Bodduluri S; UAB Lung Imaging Lab, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA., Cooper CB; Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Gravens-Mueller L; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA., Han MK; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA., Kazerooni EA; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA., Martinez FJ; Division of Pulmonary Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA., Menchaca MG; Department of Radiology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA., Ortega VE; Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA., Iii RP; Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA., Schroeder JD; Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA., Woodruff PG; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Reinhardt JM; Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA. Electronic address: joe-reinhardt@uiowa.edu.
Jazyk:	angličtina
Zdroj:	The Lancet. Digital health [Lancet Digit Health] 2023 Feb; Vol. 5 (2), pp. e83-e92.
DOI:	10.1016/S2589-7500(22)00232-1
Abstrakt:	Background: Quantitative CT is becoming increasingly common for the characterisation of lung disease; however, its added potential as a clinical tool for predicting severe exacerbations remains understudied. We aimed to develop and validate quantitative CT-based models for predicting severe chronic obstructive pulmonary disease (COPD) exacerbations. Methods: We analysed the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort, a multicentre study done at 12 clinical sites across the USA, of individuals aged 40-80 years from four strata: individuals who never smoked, individuals who smoked but had normal spirometry, individuals who smoked and had mild to moderate COPD, and individuals who smoked and had severe COPD. We used 3-year follow-up data to develop logistic regression classifiers for predicting severe exacerbations. Predictors included age, sex, race, BMI, pulmonary function, exacerbation history, smoking status, respiratory quality of life, and CT-based measures of density gradient texture and airway structure. We externally validated our models in a subset from the Genetic Epidemiology of COPD (COPDGene) cohort. Discriminative model performance was assessed using the area under the receiver operating characteristic curve (AUC), which was also compared with other predictors, including exacerbation history and the BMI, airflow obstruction, dyspnoea, and exercise capacity (BODE) index. We evaluated model calibration using calibration plots and Brier scores. Findings: Participants in SPIROMICS were enrolled between Nov 12, 2010, and July 31, 2015. Participants in COPDGene were enrolled between Jan 10, 2008, and April 15, 2011. We included 1956 participants from the SPIROMICS cohort who had complete 3-year follow-up data: the mean age of the cohort was 63·1 years (SD 9·2) and 1017 (52%) were men and 939 (48%) were women. Among the 1956 participants, 434 (22%) had a history of at least one severe exacerbation. For the CT-based models, the AUC was 0·854 (95% CI 0·852-0·855) for at least one severe exacerbation within 3 years and 0·931 (0·930-0·933) for consistent exacerbations (defined as ≥1 acute episode in each of the 3 years). Models were well calibrated with low Brier scores (0·121 for at least one severe exacerbation; 0·039 for consistent exacerbations). For the prediction of at least one severe event during 3-year follow-up, AUCs were significantly higher with CT biomarkers (0·854 [0·852-0·855]) than exacerbation history (0·823 [0·822-0·825]) and BODE index 0·812 [0·811-0·814]). 6965 participants were included in the external validation cohort, with a mean age of 60·5 years (SD 8·9). In this cohort, AUC for at least one severe exacerbation was 0·768 (0·767-0·769; Brier score 0·088). Interpretation: CT-based prediction models can be used for identification of patients with COPD who are at high risk of severe exacerbations. The newly identified CT biomarkers could potentially enable investigation into underlying disease mechanisms responsible for exacerbations. Funding: National Institutes of Health and the National Heart, Lung, and Blood Institute. Competing Interests: Declaration of interests EAH has received grants from the National Institutes of Health (NIH) and American Lung Association (ALA); has received royalties from VIDA Diagnostics; is a participant on Siemens photon counting CT advisory board; and is founder and shareholder of VIDA Diagnostics. JG has received grants from NIH and is a shareholder of VIDA Diagnostics. APC has received grants from NIH and is a paid consultant for GlaxoSmithKline and AstraZeneca. JDN has received grants from NIH and VIDA Diagnostics; has received royalties from Elsevier; and has received consulting fees, honoraria for lectures, travel expenses, fees for leadership roles, is also shareholder for, shares multiple patents with, and has received computer equipment from VIDA Diagnostics. PN has received grants from the NIH and honoraria from the GE Medical–University of Washington Imaging Symposium. SF has received grants from the American Thoracic Society, Fisher, and Paykel; and has served as a consultant for Genentech. GEC has received grants from the NIH; royalties from VIDA Diagnostics; fees for consultancy work from PowerPollen; and holds stocks or stock options in PowerPollen. FA has received grants from the NIH. IZB has received grants from Theravance & Viatris; fees for consultancy work from Theravance & Viatris, GlaxoSmithKline, AstraZeneca, and GE Healthcare; payment or honoraria for lectures, presentations, speaking, bureaus, manuscript writing, or educational events from Theravance & Viatris, AstraZeneca, and Grifols; is a participant on a data safety monitoring board for Theravance & Viatris, GlaxoSmithKline, and AstraZeneca; and is a member of the American Thoracic Society pulmonary function test committee. RGB has received grants from the NIH, the National Heart, Lung, and Blood Institute (NHLBI), The COPD Foundation, ALA, and the Foundation for the NIH; has received travel expenses from The COPD Foundation for an NIH-funded study; and has served The COPD Foundation in an unpaid leadership or fiduciary role. SPB has received grants from NIH; royalties from Springer Humana; fees for consultancy work from Boehringer Ingelheim, Sanofi/Regeneron, Sunovion, and GlaxoSmithKline; and holds stock options for Vigor Medical Systems. CBC has received grants from the NIH, The COPD Foundation, and the Foundation for the NIH; royalties from the Cambridge University Press; fees for consultancy work from Nuvaira and MGC Diagnostics; and personal fees from GlaxoSmithKline, and medicolegal personal fees from various law firms. MKH has received grants from the NHLBI, Sanofi, Novartis, Nuvaira, Sunovion; royalties from UpToDate and Norton Publishing; fees for consultancy work from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pulmonx, Teva, Verona, Merck, Sanofi, DevPro, Aerogen, and United Therapeutics; payments or honoraria from Cipla, Chiesi, Astra Zeneca, Boehringer Ingelheim, and GlaxoSmithKline; has participated on a data safety monitoring board or advisory board for Novartis and MedTronic; and is a member of The COPD Foundation Board, The COPD Foundation Scientific Advisory Committee, and ALA advisory committee. FJM has received grants from NHLBI, AstraZeneca, Chiesi, GlaxoSmithKline, and Sanofi/Regeneron; fees for consultancy work from Astra Zeneca, Boehringer Ingelheim, Chiesi, CsL Behring, Gala, GlaxoSmithKline, Novartis, Polarean, PulmonX, Sanofi/Regeneron, Sunovion, Teva, Theravance & Viatris, and Virona; payment or honoraria for lectures, presentations, speaking, bureaus, manuscript writing, or educational events from UpToDate; and is a member of the data safety monitoring board of MedTronic. MGM has received grants from the NIH and NHLBI. VEO is member of an independent data safety monitoring board for Sanofi and Regeneron. RP has received grants from NHLBI, The COPD Foundation, and Department of Veteran Affairs; and has received fees for consultancy work from Partner Therapeutics. PGW has received grants from The COPD Foundation, and Genentech; fees for consultancy work from Glenmark Pharmaceuticals, the University of Wisconsin, NGM Pharma, GlaxoSmithKline, Theravance, Sanofi, and AstraZeneca; and honoraria from the Western Society of Allergy, Asthma and Immunology. JMR has received grants from the NHLBI, and The Roy J Carver Charitable Trust; royalties from VIDA Diagnostics; personal fees from Boehringer Ingelheim; payment for expert testimony from Desmarais LLP; and is a shareholder of VIDA Diagnostics. All other authors declare no competing interests. (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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