Key result
Standardized radiographic pulmonary congestion assessment linked to ~140% higher long-term mortality in COPD exacerbation.
Why the study?
Does a standardized assessment of pulmonary congestion on chest radiographs better predict long-term mortality and identify concomitant heart failure in patients admitted for acute exacerbation of COPD compared to routine assessment?
Cohort (n=99)
Blinded investigators
No
Does a standardized assessment of pulmonary congestion on chest radiographs better predict long-term mortality and identify concomitant heart failure in patients admitted for acute exacerbation of COPD compared to routine assessment?
A standardized, liberal assessment of chest radiographs for pulmonary congestion during COPD exacerbations better identifies patients with concomitant heart failure who are at an increased risk of long-term mortality compared to routine clinical assessment.
Standardized CXR assessment may aid mortality risk stratification in AECOPD; leaves open whether it improves outcomes or guides HF therapy.
BACKGROUND: Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD). Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD) is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy. PURPOSE: We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations. MATERIAL AND METHODS: This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated. RESULTS: The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16%) ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022), and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2-4.7) (P=0.016) and NT-proBNP (relative concentration 1.8, CI 1.2-2.6) (P=0.003). CONCLUSION: By applying a standardized approach when evaluating pulmonary congestion on chest radiographs during AECOPD, a group of patients with increased risk of dying, possibly due to heart failure, is identified.
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Høiseth et al. (2013) conducted a cohort in Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n=99). Standardized assessment of pulmonary congestion on chest radiograph vs. Routine clinical assessment was evaluated on Long-term mortality (HR 2.4, 95% CI 1.2-4.7, p=0.016). A standardized assessment of pulmonary congestion on chest radiographs during acute exacerbation of COPD significantly predicted long-term mortality (HR 2.4) and was superior to routine assessment.
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