박혜윤 (삼성서울병원, 성균관대학교) | 한빛사논문 > 한빛사

한빛사논문

조회93

삼성서울병원, 성균관대학교

CV File

Chest, July 28, 2026 | https://doi.org/10.1016/j.chest.2026.07.5214 Low levels of emphysema burden on LDCT and spirometry-based OLD: Joint Effects on Mortality

Danbee Kang^1,2,3,∗ ∙ Yoosoo Chang^2,4,5,∗ ∙ You Jin Oh⁶ ∙ Jung Hye Hwang⁷ ∙ Sun Hye Shin⁸ ∙ Seungho Ryu^2,4,5 ∙ Ho Yun Lee, MD^6,9,∗∗ ∙ Hye Yun Park^1,8,∗∗

¹Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
²Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea (the Republic of)
³Trend sensing & risk modeling center, institution of cancer quality of life, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁴Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁵Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁶Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea (the Republic of)
⁷Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁸Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
⁹Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

^∗Kang and Chang equally contributed to this work as co-first authors
^∗∗Park and Lee equally contributed to this work as co-corresponding authors

Abstract

Background
Theprognostic value of low levels of CT-defined emphysema and their interaction with obstructive lung disease (OLD) remains unclear.

Research Question
Does emphysema, as defined by low-attenuation areas (LAA-950) on CT, confer differential mortality risk according to the presence of airflow limitation?

Study Design and Methods
We included 5,276 adults who underwent low-dose CT and spirometry between 2010 and 2019. Mortality was ascertained through linkage with national death records. Cox models estimated hazard ratios (HRs) for mortality according to LAA-950 and OLD. Dose-response relationships were assessed using restricted cubic splines, and progression was evaluated among participants with low baseline emphysema.

Results
Among 5,276 adults in a health-screening cohort, 66.3% were men and 47.2% were ever smokers. Over a median follow-up of 12.9 years, LAA-950 ≥1.5% alone (HR 1.32, 95% CI 0.85 to 2.06) and OLD alone (HR 0.95, 95% CI 0.50 to 1.80) were not associated with mortality. Their combination increased risk (HR 3.10, 95% CI 1.77 to 5.42; p for interaction = 0.04). A graded association between emphysema and mortality was observed only in individuals with OLD. In stratified analyses, emphysema was associated with mortality in never smokers without OLD, whereas a joint effect was observed in ever smokers. Among participants with LAA-950 <1.5%, progression to ≥1.5% increased mortality in those with OLD (HR 3.97, 95% CI 1.23 to 12.90), but not in those without OLD.

Interpretation
Low-level CT-defined emphysema was associated with higher all-cause mortality mainly when accompanied by spirometry-defined OLD. These findings suggest that low-level LAA-950 may have greater prognostic relevance in the presence of airflow limitation.

논문정보