Anticipatory significance of CT-derived pulmonary arterial metrics for recurrent exacerbations in COPD patients

Objective To investigate whether CT-derived indices of pulmonary vascularisation are associated with a high risk of exacerbation recurrence in chronic obstructive pulmonary disease (COPD). Method All clinical data related to smoking history and respiratory function tests, as well as CT-derived indices such as mean pulmonary artery density, vascular lumen dilation and pulmonary vascular pruning, were collected. Logistic regression was employed to determine whether the above factors were associated with recurrent exacerbations during the 12-month follow-up. Result Tobacco use was associated with an increased risk of frequent exacerbations, while lower lung function indices (FEV1 and FVC) were also linked to a higher exacerbation frequency. Arterial blood gas abnormalities, including lower SaO2 and elevated PaCO2, were associated with more severe COPD exacerbations. Among the CT-derived parameters, pulmonary artery dilation, mean pulmonary artery density, and pulmonary vascular pruning were all significantly associated with a higher frequency of exacerbations. Multivariable regression analysis identified pulmonary artery dilation as an independently associated factor of frequent exacerbations during follow-up, with an AUC of 0.763 on ROC analysis. Conclusion While CT-derived pulmonary vascular parameters correlate with exacerbation frequency, the direction of the association is complex and requires further prospective investigation. Our results suggest that CT-assessed vascular remodeling may aid in identifying distinct phenotypic groups, but caution is warranted in its application for individual clinical decision-making. This study provides a preliminary, hypothesis-generating basis for future research.