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Tracheobronchial Tree Size as a Predictor of Disease Severity and Outcomes in Idiopathic Pulmonary Fibrosis

2017; Elsevier BV; Volume: 152; Issue: 4 Linguagem: Inglês

10.1016/j.chest.2017.08.514

1931-3543

Ankush P. Ratwani, Christopher R. King, Whitney Brown, Oksana A. Shlobin, Nargues Weir, Steven D. Nathan,

Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis

SESSION TITLE: Diffuse Lung Disease I SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 03:15 PM - 04:15 PM PURPOSE: It has become vital to diagnosis Idiopathic Pulmonary Fibrosis (IPF) early, and have a practical noninvasive way to predict disease severity. We hypothesize that changes in tracheobronchial tree size correlate with disease severity and might be a predictive factor for mortality. METHODS: IPF patients evaluated between March 2012 and December 2016 at the Inova Advanced Lung Disease Program formed the study cohort. Basic demographics were collected including: age, gender, lung volumes, and BMI. Initial high resolution chest CT (HRCT) were evaluated with measurements at levels along the tracheobronchial tree which included: Anterior-Posterior (AP) diameter at the sub-glottic level, aortic arch (AA), carina, right main stem bronchus (RMSB) and left main stem bronchus (LMSB). Transverse (TV) diameter was assessed at the level of the sub-glottis, AA and carina. Primary outcomes included correlation between tracheobronchial tree size and GAP index by stage along with lung volumes. SPSS was used for statistical analysis. RESULTS: There were 150 patients with available HRCTs for analysis. The mean (range) AP tracheal diameters for the sub-glottis, AA, carina, RMSB and LMSB were: 21.77 mm (13-45), 21.84 mm (10-33), 20.47 mm (11-37), 15.19 mm (8-26), 14.21 mm (6-27), respectively. The transverse diameters for sub-glottis, AA and carina were 16.69 mm (10-41), 19.34 mm (13-37), and 23 mm (15-34), respectively. Average GAP index points and stage was 5 and 2, respectively. Using a one way ANOVA between Gap index and tracheal measurements there was a significant difference between means of all 8 groups with an increase in GAP index stage for every level of increase in tracheal measurements (P < 0.005). Using Pearson’s method we found a significant positive correlation for all 8 groups (Table 1). There was no correlation between tracheal measurements and FVC% predicted. Using multivariate log regression there was weak model fit between GAP Index and tracheal measurements (R2 = 0.279, p < 0.001). CONCLUSIONS: There was a significant correlation between GAP Index and increasing tracheobronchial tree size. We did not see the same correlation when comparing tracheal measurements to FVC% predicted indicating that tracheal enlargement is likely not related to fibrosis alone and that other factors may be involved. CLINICAL IMPLICATIONS: Based on this data, further studies are needed to determine whether tracheal size is an independent prognostic factor for morality in patients with IPF. DISCLOSURE: The following authors have nothing to disclose: Ankush Ratwani, Christopher King, Whitney Brown, Oksana Shlobin, Nargues Weir, Steven Nathan No Product/Research Disclosure Information