Relationship of spirometric, body plethysmographic, and diffusing capacity parameters to emphysema scores derived from CT scans

Kathrin Kahnert, Bertram Jobst, Frank Biertz, Jürgen Biederer, Henrik Watz, Rudolf M Huber, Jürgen Behr, Philippe A Grenier, Peter Alter, Claus F Vogelmeier, Hans-Ulrich Kauczor, Rudolf A Jörres, Kathrin Kahnert, Bertram Jobst, Frank Biertz, Jürgen Biederer, Henrik Watz, Rudolf M Huber, Jürgen Behr, Philippe A Grenier, Peter Alter, Claus F Vogelmeier, Hans-Ulrich Kauczor, Rudolf A Jörres

Abstract

Phenotyping of chronic obstructive pulmonary disease (COPD) with computed tomography (CT) is used to distinguish between emphysema- and airway-dominated type. The phenotype is reflected in correlations with lung function measures. Among these, the relative value of body plethysmography has not been quantified. We addressed this question using CT scans retrospectively collected from clinical routine in a large COPD cohort. Three hundred and thirty five patients with baseline data of the German COPD cohort COPD and Systemic Consequences-Comorbidities Network were included. CT scans were primarily evaluated using a qualitative binary emphysema score. The binary score was positive for emphysema in 52.5% of patients, and there were significant differences between the positive/negative groups regarding forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC), intrathoracic gas volume (ITGV), residual volume (RV), specific airway resistance (sRaw), transfer coefficient (KCO), transfer factor for carbon monoxide (TLCO), age, pack-years, and body mass index (BMI). Stepwise discriminant analyses revealed the combination of FEV1/FVC, RV, sRaw, and KCO to be significantly related to the binary emphysema score. The additional positive predictive value of body plethysmography, however, was only slightly higher than that of the conventional combination of spirometry and diffusing capacity, which if taken alone also achieved high predictive values, in contrast to body plethysmography. The additional information on the presence of CT-diagnosed emphysema as conferred by body plethysmography appeared to be minor compared to the well-known combination of spirometry and CO diffusing capacity.

Keywords: COPD; CT scan; body plethysmography; emphysema; lung function.

Conflict of interest statement

Declaration of conflicting interests: Kathrin Kahnert, Bertram Jobst, Frank Biertz, Jürgen Biederer, Henrik Watz, Rudolf M Huber, Jürgen Behr, Rudolf A Jörres declare no competing interests and have nothing to disclose. Claus F Vogelmeier gave presentations at symposia and/or served on scientific advisory boards sponsored by AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Menarini, Mundipharma, Novartis, Teva, Cipla, Omniamed, and MedUpdate. Hans-Ulrich Kauczor declares no competing interests and has nothing to disclose with regard to the content of the article. Philippe A Grenier has nothing to disclose with regard to the content of the article.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic (ROC) curves for different combinations of predictors. This figure shows the ROC curves for different combinations of predictors, either spirometry, body plethysmography, and diffusing capacity (blue); or spirometry and diffusing capacity (green); or spirometry (brown), diffusing capacity (yellow), and body plethysmography (purple) separately. The sets of parameters for the different combinations are given in the results section, and the corresponding AUC are given in Table 2. AUC: areas under the curve.
Figure 2.
Figure 2.
Relationship between the 15th percentile and the prediction score. The figure shows the predicted values from multivariate regression against the observed values of the 15th percentile of MLD. The regression equation comprised KCO%pred, ITGV%pred, FEV1/FVC%pred, and BMI (see text). The black circles indicate patients with positive binary emphysema score and the grey circles indicate patients with negative binary score. MLD: mean lung density; KCO: transfer coefficient; ITGV: intrathoracic gas volume; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; BMI: body mass index.

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