Assessing the Efficacy of Modified CT Severity Index Versus Conventional CT Severity Index in Determining Severity and Clinical Outcomes of Chronic Obstructive Pulmonary Disease (COPD)

Abstract

The aim of this study was to evaluate the severity of chronic obstructive pulmonary disease (COPD) using the computed tomography severity index (CTSI) and the modified CTSI (MCTSI) and to assess their correlation with clinical outcome measures. Additionally, the study aimed to compare the diagnostic performance of these indices in predicting moderate to severe COPD, based on patient outcomes. Materials and methodsIn this prospective study, conducted between November 2023 and March 2024, two radiologists, blinded to clinical outcomes, independently assessed CTSI and MCTSI. Clinical outcomes evaluated included the duration of hospital stay, intensive care unit (ICU) stay, organ failure (OF), evidence of infection, need for intervention, and mortality. ResultsThe study included 60 COPD patients, with a majority being male (40, 66.7%) and a mean age of 65.4 ± 8.6 years. Based on CTSI, severity was classified as mild in 25 (41.7%), moderate in 20 (33.3%), and severe in 15 (25.0%) cases. According to MCTSI, severity was classified as mild in 22 (36.7%), moderate in 15 (25.0%), and severe in 23 (38.3%) cases. MCTSI showed concordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification in 54 (90.0%) cases, while CTSI was concordant in 47 (78.3%) cases. For predicting moderate to severe COPD, CTSI demonstrated a sensitivity of 91.4%, specificity of 96.0%, positive predictive value (PPV) of 97.1%, and overall accuracy of 98.3%. MCTSI showed a sensitivity of 94.4%, specificity of 92.0%, PPV of 94.4%, and accuracy of 96.7%. Both indices correlated significantly with clinical outcomes, including OF, need for intervention, infection, and mortality (p < 0.001), although no significant correlation was found with ICU stay. ConclusionBoth CTSI and MCTSI demonstrated a strong correlation with clinical outcomes in COPD patients and showed good concordance with severity assessments. MCTSI exhibited higher sensitivity, while CTSI demonstrated greater specificity for differentiating mild from moderate/severe COPD cases. These indices can be valuable tools in guiding clinical decision-making and assessing disease severity in COPD.