Author/Editor		Wells, Michael J; Washko, George R; Han, MeiLan K; Košnik, Mitja
Title		Pulmonary arterial enlargement and acute exacerbations of COPD
Type		članek
Source		N Engl J Med
Vol. and No.		Letnik 367, št. 10
Publication year		2012
Volume		str. 913-21
Language		eng
Abstract		Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. Methods: We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. Results: Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P<0.001). A PA:A ratio of more than 1 was also independently associated with an increased risk of future severe exacerbations in both the trial cohort (odds ratio, 3.44; 95% CI, 2.78 to 4.25; P<0.001) and the external validation cohort (odds ratio, 2.80; 95% CI, 2.11 to 3.71; P<0.001). (Abs. trunc. at 2000 ch.)
Descriptors		LUNG DISEASES, OBSTRUCTIVE HYPERTENSION, PULMONARY TOMOGRAPHY, X-RAY COMPUTED PULMONARY ARTERY AORTA ACUTE DISEASE AGED AORTA AORTOGRAPHY LOGISTIC MODELS RECURRENCE RISK FACTORS SMOKING