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Original Research: COPD |

Emphysema Scores Predict Death From COPD and Lung CancerLow-Dose CT Scan Predicts Death From COPD

Javier J. Zulueta, MD, FCCP; Juan P. Wisnivesky, MD, DrPH; Claudia I. Henschke, PhD, MD; Rowena Yip, MPH; Ali O. Farooqi, MD; Dorothy I. McCauley, MD; Mildred Chen, MD; Daniel M. Libby, MD; James P. Smith, MD; Mark W. Pasmantier, MD; David F. Yankelevitz, MD
Author and Funding Information

From the Department of Pulmonary Medicine (Dr Zulueta), Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain; Divisions of General Internal Medicine and Pulmonary, Critical Care and Pulmonary Medicine (Dr Wisnivesky) and Department of Radiology (Drs Henschke, Farooqi, and Yankelevitz and Ms Yip), Mount Sinai School of Medicine, New York, NY; and Department of Radiology (Drs McCauley and Chen) and Department of Medicine and Division of Pulmonary and Critical Care Medicine (Drs Libby, Smith, and Pasmantier), Weill Cornell Medical College, New York, NY.

Correspondence to: Claudia I. Henschke, PhD, MD, Department of Radiology, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029; e-mail: Claudia.Henschke@mountsinai.org


Funding/Support: This report has been funded in part by the Flight Attendants Medical Research Institute. The screening studies were partly supported by National Institutes of Health [R01-CA-63393]; the City of New York, Department of Health and Mental Hygiene; New York State Office of Science, Technology and Academic Research (NYSTAR); General Electric; Kodak; Empire Blue Cross and Blue Shield; The Starr Foundation; Ernest E. Stempel Foundation; The New York Community Trust; The Rogers Family Fund; and AMDeC Foundation, Inc. No tobacco funds were used in the acquisition of the data and images or in the analysis.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1216-1223. doi:10.1378/chest.11-0101
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Objective:  Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.

Methods:  Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came first. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death.

Results:  Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P < .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history.

Conclusions:  Visual assessment of emphysema on CT scan is a significant predictor of death from COPD and lung cancer.

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