Obvious emphysema on computed tomography during an acute exacerbation of chronic obstructive pulmonary disease predicts a poor prognosis

Background Emphysematous change on computed tomography (CT) during the stable phase of chronic obstructive pulmonary disease (COPD) is reported to correlate with COPD prognosis. Acute exacerbation of COPD (AECOPD) is associated with a high risk of mortality and a poor prognosis. Aims This study aims to study the relationship between prognosis and emphysematous changes on CT during an AECOPD. Methods Histories were recorded, and CT acquired for 106 patients who visited the emergency department for an AECOPD. Emphysematous change was quantified by measuring the percentage of low‐attenuation areas (LAA%) in the entire lung on CT images with a threshold of –950 Hounsfield units. Other factors that could influence AECOPD prognosis were also recorded on admission and analysed. At follow ups conducted in 1 year, patient survival, the modified Medical Research Council (mMRC) Dyspnoea Scale, and performance status (PS) were evaluated, and a COPD Assessment Test (CAT) was completed. Results The 1‐year follow up was completed by 103 of 106 patients. The median LAA% was significantly higher in non‐survivors (11%, n = 16) than in survivors (5.69%, n = 87) (P = 0.006) at the 1‐year follow up. LAA% was significantly correlated with mMRC grade (r = 0.285, P = 0.008), PS (r = 0.397, P < 0.001) and CAT score (r = 0.27, P = 0.017) at the 3‐month follow up, and with mMRC grade (r = 0.405, P < 0.001) and PS (r = 0.377, P < 0.001) at the 1‐year follow up. LAA% > 7.5% was a significant predictor of 1‐year mortality, higher mMRC and PS at the 3‐month and 1‐year follow ups, after adjustment for other prognostic predictors. Conclusion Obvious emphysematous changes on CT (LAA% > 7.5%) during an AECOPD predicts a poor prognosis independent of other known indicators.