• Spyridon Fortis, Junfeng Guo, Prashant Nagpal, Muhammad F A Chaudhary, John D Newell, Sarah E Gerard, MeiLan K Han, Ella A Kazerooni, Fernando J Martinez, Igor Z Barjaktarevic, R Graham Barr, Sandeep Bodduluri, Robert Paine Iii, Hira A Awan, Joyce D Schroeder, Lisa D Gravens-Mueller, Victor E Ortega, Wayne H Anderson, Christopher B Cooper, David Couper, Prescott G Woodruff, Russell P Bowler, Surya P Bhatt, Eric A Hoffman, Joseph M Reinhardt, and Alejandro P Comellas.
• University of Iowa Hospitals and Clinics, Division of Pulmonary, Critical Care and Occupation Medicine, Iowa City, Iowa, United States; spyridon-fortis@uiowa.edu.
• Am. J. Respir. Crit. Care Med. 2024 Jun 6.

RationalGround glass opacities (GGO) in the absence of interstitial lung disease are understudied.ObjectiveTo assess the association of GGO with white blood cells (WBCs) and progression of quantified chest CT emphysema.MethodsWe analyzed data of participants in the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS). Chest radiologists and pulmonologists labeled regions of the lung as GGO and adaptive multiple feature method (AMFM) trained the computer to assign those labels to image voxels and quantify the volume of the lung with GGO (%GGOAMFM). We used multivariable linear regression, zero-inflated negative binomial, and proportional hazards regression models to assess the association of %GGOAMFM with WBC, changes in %emphysema, and clinical outcomes.Measurements And Main ResultsAmong 2,714 participants, 1,680 had COPD and 1,034 had normal spirometry. Among COPD participants, based on the multivariable analysis, current smoking and chronic productive cough was associated with higher %GGOAMFM. Higher %GGOAMFM was cross-sectionally associated with higher WBCs and neutrophils levels. Higher %GGOAMFM per interquartile range at visit 1 (baseline) was associated with an increase in emphysema at one-year follow visit by 11.7% (Relative increase; 95%CI 7.5-16.1%;P<0.001). We found no association between %GGOAMFM and one-year FEV1 decline but %GGOAMFM was associated with exacerbations and all-cause mortality during a median follow-up time of 1,544 days (Interquartile Interval=1,118-2,059). Among normal spirometry participants, we found similar results except that %GGOAMFM was associated with progression to COPD at one-year follow-up.ConclusionsOur findings suggest that GGOAMFM is associated with increased systemic inflammation and emphysema progression.

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