CT評価間質性肺病変コホート：死亡予後悪化

4つの研究コホートで、CTにて間質性肺病変確認した症例はその後予後は悪い
おそらく、間質性肺炎のため・・・



Association Between Interstitial Lung Abnormalities and All-Cause Mortality
Rachel K. Putman,  et. al.; for the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and COPDGene Investigators
JAMA. 2016;315(7):672-681. doi:10.1001/jama.2016.0518.

前向きコホート

FHS (Framingham Heart Study; computed tomographic [CT] scans obtained September 2008-March 2011) 2633

AGES-Reykjavik Study (Age Gene/Environment Susceptibility; recruited January 2002-February 2006) 5320
 

COPDGene Study (Chronic Obstructive Pulmonary Disease; recruited November 2007-April 2010) 2068

ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; between December 2005-December 2006)　 1670

胸部CT評価
・間質性肺病変： FHS　177 (7%)/2633 、AGES-Reykjavik　378 (7%) /5320 ,  COPDGene　156 (8%) /　2068 、ECLIPSE157 (9%) / 1670




・約3-9年間のフォローアップ中央値において、間質性肺病変を有する場合の死亡率は無い場合に比べ高率　:FHS 7% vs 1% (6% difference [95% CI, 2% to 10%])、AGES-Reykjavik　56% vs 33% (23% difference [95% CI, 18% to 28%])、ECLIPSE 11% vs 5%  (6% difference [95% CI, 1% to 11%])




 ・寄与要素補正後、間質性肺病変は、死亡リスク増加と関連
FHS (hazard ratio [HR], 2.7 [95% CI, 1.1 to 6.5]; P = .03)
AGES-Reykjavik (HR, 1.3 [95% CI, 1.2 to 1.4]; P < .001)
COPDGene (HR, 1.8 [95% CI, 1.1 to 2.8]; P = .01)
ECLIPSE (HR, 1.4 [95% CI, 1.1 to 2.0]; P = .02)






 AGES-Reykjavikコホートにおいて、死亡率高率なのは、呼吸器系疾患、特に肺線維症にて説明可能であった