The Association of Interstitial Lung Abnormalities and Preserved Ratio Impaired Spirometry With Mortality.

IF 8.6 1区医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-07-01 Epub Date: 2025-02-11 DOI:10.1016/j.chest.2025.02.002

Sean Kalra, Brian Hobbs, Gary M Hunninghake, Aravind A Menon, Rachel Putman, Claire Cutting, Hiroto Hatabu, Edwin K Silverman, Emily Wan, Michael H Cho, Matthew Moll

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Abstract

Background: Preserved ratio impaired spirometry (PRISm) findings are heterogeneous and include restrictive lung disease. Interstitial lung abnormalities (ILAs) may represent early interstitial lung disease. The relationship between PRISm and ILAs is not well understood.

Research question: What is the prevalence of ILAs in PRISm compared with normal spirometry findings, what are risk factors for ILAs within PRISm, and how do ILAs modify the association of PRISm and mortality?

Study design and methods: In Genetic Epidemiology of COPD study participants with baseline spirometry results and chest CT scans, we examined those with normal spirometry findings (FEV₁ ≥ 80% predicted and FEV₁ to FVC ≥ 0.7) and PRISm (FEV₁ < 80% predicted with FEV₁ to FVC ratio ≥ 0.7) with and without ILAs, per Fleischner Society guidelines. We used logistic regression to examine the odds of ILAs in those with PRISm. We modeled all-cause mortality with Cox regression. We evaluated the association of baseline ILA status on change in spirometry findings at follow-up.

Results: We included 4,494 participants with normal spirometry findings and 1,262 participants with PRISm. ILAs were present in 93 participants (7%) with PRISm and in 180 participants (4%) with normal spirometry findings. PRISm findings were associated with increased odds (OR, 1.74; 95% CI, 1.33-2.27; P < .001) of ILAs compared with normal spirometry findings. Among participants with PRISm, older age, increased smoke exposure, lower lung function, and increased airway wall thickness were associated with ILA. ILAs were associated with increased mortality (adjusted hazard ratio, 2.58; 95% CI, 1.49-4.45).

Interpretation: Our results show that among patients with PRISm, ILAs are associated with increased all-cause mortality, as well as increased age, smoke exposure, lower lung function, and increased airway wall thickness.

Clinical trial registry: ClinicalTrials.gov; No.: NCT000608764; URL: www.

Clinicaltrials: gov.

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间质性肺异常和保留比例肺功能受损（PRISm）与死亡率的关系。

背景：保留比例肺功能受损（PRISm）是异质性的，包括限制性肺疾病。间质性肺异常（ILA）可能代表早期间质性肺疾病。PRISm和ILA之间的关系尚不清楚。研究问题：与正常肺活量测定相比，PRISm中ILA的患病率是多少？ PRISm中ILA的危险因素是什么？ ILAs如何改变PRISm与死亡率的关系？研究设计和方法：根据Fleischner学会指南，在基线肺活量测定和胸部计算机断层扫描（CT）的COPDGene参与者中，我们检查了肺活量测定正常（预测FEV1≥80%，FEV1/FVC≥0.7）和PRISm（预测FEV1 < 80%， FEV1/FVC比值≥0.7），有无ILA。我们使用逻辑回归来检验PRISm中ILA的几率。我们用Cox回归模拟了全因死亡率。我们评估了基线ILA状态与随访时肺活量测定变化的关系。结果：我们纳入了4494名肺功能正常的参与者和1262名PRISm参与者。93例（7%）PRISm患者和180例（4%）肺活量正常患者存在ILAs。与正常肺活量测定相比，PRISm与ILA的几率增加相关（1.74,95% CI 1.33-2.27, p < 0.001）。在PRISm参与者中，年龄较大、烟雾暴露增加、肺功能降低和气道壁厚度增加与ILA相关。ILAs与死亡率增加相关（相对危险度2.58,95%CI:1.49-4.45）。解释：在PRISm中，ILA与全因死亡率增加、年龄增加、烟雾暴露、肺功能降低和气道壁厚度增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.