Clinical and prognostic differences in mild to moderate AECOPD with and without emphysema: a 3-year multicenter prospective study.

INTRODUCTION

The prognostic significance of the computed tomography (CT)-defined emphysema phenotype in patients hospitalized with mild-to-moderate acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains poorly defined.

MATERIALS AND

METHODS

This prospective multicenter cohort study analyzed data from the MAGNET AECOPD Registry. We included patients hospitalized with mild-to-moderate AECOPD (Rome criteria) who underwent chest CT within 24 h of admission. Participants were categorized into emphysema and non-emphysema groups based on visual CT assessment. The primary outcome was 3-year all-cause mortality; secondary outcomes included rehospitalization and in-hospital events. Propensity score matching balanced baseline characteristics.

RESULTS

Among 5,713 eligible patients, 4,558 (79.8%) had emphysema. After 1:1 propensity score matching (n = 2,258), the emphysema group demonstrated more severe acute disease, with higher proportions of respiratory failure (12.1% vs. 3.4%, p < 0.001), and elevated inflammatory markers (all p < 0.001). Interestingly, the emphysema group exhibited significantly lower 3-year all-cause mortality (24.8% vs. 30.2%, log-rank p = 0.048) despite higher rates of non-invasive ventilation requirement (24.1% vs. 19.1%, p = 0.005) and longer hospital stays (11 vs. 10 days, p < 0.001). The non-emphysema group carried a heavier burden of cardiovascular comorbidities including hypertension (41.5% vs. 32.7%, p < 0.001) and heart failure (18.7% vs. 13.6%, p = 0.001).

CONCLUSION

In mild-to-moderate AECOPD, the emphysema phenotype predicts higher acute morbidity yet lower long-term mortality. This finding suggests potential distinct pathophysiological pathways and supports further investigation of CT-based phenotyping for personalized management in COPD.

CLINICAL TRIAL REGISTRATION: http://www.chictr.org.cn/showproj.aspx?proj=121626, Identifier ChiCTR2100044625.