Format

Send to

Choose Destination
Am J Respir Crit Care Med. 2017 Dec 1;196(11):1434-1442. doi: 10.1164/rccm.201703-0555OC.

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

Author information

1
1 Department of Medicine.
2
2 Department of Epidemiology, and.
3
3 Department of Radiology.
4
4 Department of Internal Medicine, and.
5
5 Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa.
6
6 Department of Biostatistics and.
7
7 Department of Biostatistics, Columbia University Medical Center, New York, New York.
8
8 Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; and.
9
9 Department of Medicine, University of Washington, Seattle, Washington.
10
10 Department of Medicine and.
11
11 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

RATIONALE:

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).

OBJECTIVES:

To determine whether high-attenuation areas are associated with the risk of ILD hospitalization and mortality in the general population.

METHODS:

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.

MEASUREMENTS AND MAIN RESULTS:

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; Pā€‰<ā€‰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; Pā€‰<ā€‰0.001). Our findings were consistent among both smokers and nonsmokers.

CONCLUSIONS:

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.

KEYWORDS:

epidemiology; hospitalizations; mortality; pulmonary fibrosis; subclinical interstitial lung disease

PMID:
28613921
PMCID:
PMC5736977
[Available on 2018-12-01]
DOI:
10.1164/rccm.201703-0555OC
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center