Association between bone attenuation on chest tomography and morbidity in patients with exacerbated COPD: a secondary analysis of a prospective cohort
DOI:
https://doi.org/10.53903/01212095.324Keywords:
Bone resorption, high-resolution CT scan, chronic obstructive pulmonary disease, exacerbation, inpatient units, mechanical ventilationAbstract
Introduction: COPD (Chronic Obstructive Pulmonary Disease) is a chronic respiratory disease that affects millions of people worldwide. Low bone mineral density (LBMD) is common in patients with COPD, related to systemic inflammation, and which can negatively affect respiratory function. Vertebral bone attenuation measured on high-resolution computed tomography (HRCT) scans has been proposed as a potential risk marker, but its usefulness in the clinical setting of exacerbated COPD (E-COPD) has not yet been clearly established. Objectives: This study estimates the association between vertebral bone attenuation measured in HRCT scans and the outcomes of admission to Intensive Care Units or Special Care Units (ICU/SCU), hospital length-stay and requirement for mechanical ventilation in hospitalized patients with E-COPD. A secondary objective was to determine whether simple region of interest (ROI) measurement is equivalent to volumetric ROI measurement. Methods: A secondary analysis of the data was performed in the prospective cohort of adults treated in the emergency departments of three reference hospitals in Medellín (Colombia), who consulted for E-COPD and required hospitalization between March 2018 and March 2021. Patients with an HRCT scan within the first 36 hours of admission were included. Vertebral bone attenuation was measured by simple and semi-automatic volumetric ROI in the vertebral bodies T4, T7, T10 and L1 using Horos v4.0.0 RC5 software for Mac. The association between radiological measurements and outcomes was determined by multivariate logistic regression and Cox models. Results: A total of 323 patients were included. Volumetric bone attenuation did not show a significant association with admission to the ICU/SCU, hospital lenght-stay, or the need for mechanical ventilation,
in the multivariate analysis. The correlation coefficient for the measurement methods with volumetric and simple ROI was 0.98 and according to the Bland and Altman diagram, an average difference measure of 0.78. Conclusion: Vertebral bone attenuation had no significant associations with ICU/SCU admission, the need for mechanical ventilation, or length of hospital stay in an episode of E-COPD. The agreement between bone attenuation measurement methods suggests that simple ROI is a fast, useful, and reproducible tool for future research.
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