QUANTITATIVE COMPUTER TOMOGRAPHY MEASURES OF BODY COMPOSITION AND THE ASSOCIATION WITH MORTALITY, ALL CAUSE, COPD AND PNEUMONIA RELATED HOSPITAL ADMISSION IN A LARGE LUNG CANCER SCREENING COHORT

Abstract

TOPIC: Imaging TYPE: Original Investigations PURPOSE: Patients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. CT quantified muscle area has been shown to be associated with mortality, lung cancer, chronic obstructive pulmonary disease (COPD) severity and exacerbations. We sought to examine if quantitatively assessed measures of body composition on CTLS scans can identify patients at increased risk for mortality, and all cause, COPD and pneumonia related hospitalization in a large clinical CTLS cohort. METHODS: Patients (n=1703) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2014 and had an in network primary care physician were included. Clinical outcomes data was collected through September 30, 2019. Quantitative measurements of pectoralis muscle area (PMA) and subcutaneous fat area (SFA) were performed on a single axial slice of the CT above the aortic arch with the Chest Imaging Platform Workstation software. PMA, SFA and liver density were dichotomized into quartiles separately for each sex and combined to account for baseline differences between sexes. Multivariable Cox regression models were used to evaluate the association between quantitative measures of body composition and mortality, hospitalization, COPD-related, and pneumonia-related hospitalization. To adjust for multiplicity Bonferroni correction was utilized and p-value significance was set at ≤ 0.004. All statistical analyses were performed using STATA14.1. RESULTS: Of the 1,703 patients who met the inclusion criteria and underwent CTLS, a total of seven patients were excluded secondary to failure of the Chest Imaging Platform program to analyze the scans. There were a total of 137 (8.1%) deaths during the study, 652 (38.4%) of the subjects were admitted to the hospital at least once, 74 (4.4%) were admitted for COPD and 97 (5.7%) were admitted for pneumonia related hospitalizations. The lowest quartile of PMA was found to be associated with an increased risk for mortality and COPD related hospital admission HR 3.10 (1.84, 5.21), p<0.001 and HR 3.24 (1.45, 7.22), p =0.004. The lowest quartile of liver density was found to be associated with an increased risk for all cause, COPD and pneumonia related hospital admission HR 1.73 (1.34, 2.24), p<0.001, HR 3.32 (1.53, 7.20), p =0.002 and HR 2.95 (1.46, 5.97), p =0.003. CONCLUSIONS: Quantitative measure of PMA are associated with an increased risk for mortality and COPD related hospital admission. Liver density measurements are associated with an increased risk for all cause, COPD and pneumonia related hospital admissions. CLINICAL IMPLICATIONS: Quantitative measurements of body composition on CTLS exams in these patients can be used to extrapolate risk for mortality and hospital admissions. Allowing clinicians to identify at risk patients, impacting clinical decision making and patient care. DISCLOSURES: No relevant relationships by Alissa Ali, source=Web Response Grant funding relationship with Genentech Please note: 9/10/2020 Added 04/23/2021 by Lee Gazourian, source=Web Response, value=Grant/Research Support Consultant relationship with Veracyte Please note: 2019-2021 Added 06/23/2021 by Carla Lamb, source=Web Response, value=Honoraria No relevant relationships by Timothy Liesching, source=Web Response No relevant relationships by William Long, source=Web Response Speaker/Speaker's Bureau relationship with Covidien Please note: $1001 - $5000 by andrea mckee, source=Web Response, value=Salary Speaker/Speaker's Bureau relationship with Covidien Please note: $1-$1000 by andrea mckee, source=Web Response, value=Travel Advisor relationship with AstraZeneca Please note: 2019-2021 Added 04/22/2021 by Brady McKee, source=Web Response, value=Advisor Fee No relevant relationships by Elizabeth Pagura, source=Web Response No relevant relationships by Lori Lyn Price, source=Web Response No relevant relationships by Shawn Regis, source=Web Response research relationship with Veracyte Please note: 1/1/18-present Added 06/23/2021 by Kimberly Rieger-Christ, source=Web Response, value=Grant/Research Support No relevant relationships by Giulia Rizzo, source=Web Response Owner/Founder relationship with Quantitative Imaging Solutions Please note: 2015 Added 04/30/2021 by Raúl San José Estépar, source=Web Response, value=Ownership interest No relevant relationships by Ava Sanayei, source=Web Response No relevant relationships by Cristina Stefanescu, source=Web Response No relevant relationships by Will Thedinger, source=Web Response No relevant relationships by Christoph Wald, source=Web Response, value=Honoraria Removed 04/22/2021 by Christoph Wald, source=Web Response My spouse/partner as a Employee relationship with biogen Please note: >$100000 by George Washko, source=Web Response, value=Salary Owner/Founder relationship with Quantitative Imaging Solutions Please note: >$100000 by George Washko, source=Web Response, value=Ownership interest Advisory Committee Member relationship with Boehringer Ingelheim Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Consultant relationship with Vertex Please note: $5001 - $20000 by George Washko, source=Web Response, value=Consulting fee Advisory Committee Member relationship with PulmonX Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Advisory Committee Member relationship with CSL Behring Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Consultant relationship with Johnson and Johnson Please note: $5001 - $20000 by George Washko, source=Web Response, value=Consulting fee