High-Attenuation Areas on Chest Computed Tomography and Clinical Respiratory Outcomes in Community-Dwelling Adults

Anna J Podolanczuk; Elizabeth C Oelsner; R Graham Barr; Elana J Bernstein; Eric A Hoffman; Imaani J Easthausen; Karen Hinckley Stukovsky; Arindam RoyChoudhury; Erin D Michos; Ganesh Raghu; Steven M Kawut; David J Lederer

doi:10.1164/rccm.201703-0555OC

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High-Attenuation Areas on Chest Computed Tomography and Clinical Respiratory Outcomes in Community-Dwelling Adults

Journal article

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Peer reviewed

High-Attenuation Areas on Chest Computed Tomography and Clinical Respiratory Outcomes in Community-Dwelling Adults

Anna J Podolanczuk, Elizabeth C Oelsner, R Graham Barr, Elana J Bernstein, Eric A Hoffman, Imaani J Easthausen, Karen Hinckley Stukovsky, Arindam RoyChoudhury, Erin D Michos, Ganesh Raghu, …

American journal of respiratory and critical care medicine, Vol.196(11), pp.1434-1442

12/01/2017

DOI: 10.1164/rccm.201703-0555OC

PMCID: PMC5736977

PMID: 28613921

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Abstract

Areas of increased lung attenuation visualized by computed tomography are associated with all-cause mortality in the general population. It is uncertain whether this association is attributable to interstitial lung disease (ILD). To determine whether high-attenuation areas are associated with the risk of ILD hospitalization and mortality in the general population. We performed a cohort study of 6,808 adults aged 45-84 years sampled from six communities in the United States. High-attenuation areas were defined as the percentage of imaged lung volume with attenuation values between -600 and -250 Hounsfield units. An adjudication panel determined ILD hospitalization and death. After adjudication, 52 participants had a diagnosis of ILD during 75,232 person-years (median, 12.2 yr) of follow-up. There were 48 hospitalizations attributable to ILD (crude rate, 6.4 per 10,000 person-years). Twenty participants died as a result of ILD (crude rate, 2.7 per 10,000 person-years). High-attenuation areas were associated with an increased rate of ILD hospitalization (adjusted hazard ratio, 2.6 per 1-SD increment in high-attenuation areas; 95% confidence interval, 1.9-3.5; P < 0.001), a finding that was stronger among men, African Americans, and Hispanics. High-attenuation areas were also associated with an increased rate of ILD-specific death (adjusted hazard ratio, 2.3; 95% confidence interval, 1.7-3.0; P < 0.001). Our findings were consistent among both smokers and nonsmokers. Areas of increased lung attenuation are a novel risk factor for ILD hospitalization and mortality. Measurement of high-attenuation areas by screening and diagnostic computed tomography may be warranted in at-risk adults.

Lung Diseases, Interstitial - diagnostic imaging

Humans

Middle Aged

Aged, 80 and over

Tomography, X-Ray Computed - methods

Female

Male

Aged

Lung - diagnostic imaging

Lung - physiopathology

Lung Diseases, Interstitial - physiopathology

Cohort Studies

Details

Title: Subtitle: High-Attenuation Areas on Chest Computed Tomography and Clinical Respiratory Outcomes in Community-Dwelling Adults
Creators: Anna J Podolanczuk - 1 Department of Medicine
Elizabeth C Oelsner - 1 Department of Medicine
R Graham Barr - 2 Department of Epidemiology, and
Elana J Bernstein - 1 Department of Medicine
Eric A Hoffman - 5 Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
Imaani J Easthausen - 1 Department of Medicine
Karen Hinckley Stukovsky - 6 Department of Biostatistics and
Arindam RoyChoudhury - 7 Department of Biostatistics, Columbia University Medical Center, New York, New York
Erin D Michos - 8 Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; and
Ganesh Raghu - 9 Department of Medicine, University of Washington, Seattle, Washington
Steven M Kawut - 11 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David J Lederer - 2 Department of Epidemiology, and
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.196(11), pp.1434-1442
DOI: 10.1164/rccm.201703-0555OC
PMID: 28613921
PMCID: PMC5736977
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Publisher: United States
Grant note: P30 ES005605 / NIEHS NIH HHS N01HC95169 / NHLBI NIH HHS N01HC95161 / NHLBI NIH HHS T32 HL105323 / NHLBI NIH HHS R01 HL093081 / NHLBI NIH HHS N01HC95164 / NHLBI NIH HHS HHSN268201500003C / NHLBI NIH HHS N01HC95160 / NHLBI NIH HHS R01 HL112986 / NHLBI NIH HHS N01HC95167 / NHLBI NIH HHS RC1 HL100543 / NHLBI NIH HHS N01HC95159 / NHLBI NIH HHS R01 HL103676 / NHLBI NIH HHS N01HC95163 / NHLBI NIH HHS R01 HL077612 / NHLBI NIH HHS N01HC95166 / NHLBI NIH HHS K24 HL103844 / NHLBI NIH HHS UL1 TR000040 / NCATS NIH HHS N01HC95168 / NHLBI NIH HHS UL1 TR001079 / NCATS NIH HHS K24 HL131937 / NHLBI NIH HHS N01HC95165 / NHLBI NIH HHS P30 DK054759 / NIDDK NIH HHS N01HC95162 / NHLBI NIH HHS
Language: English
Date published: 12/01/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984051564402771

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