Tracheal Eccentricity is Associated with Respiratory Morbidity and Mortality in Chronic Obstructive Pulmonary Disease
- 1University of Alabama at Birmingham
Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is characterized by airway remodeling, which may affect tracheal morphology. However, the relationship between tracheal morphometry and COPD severity, quality of life, functional capacity, and mortality remains poorly understood.
ObjectiveTo investigate the associations between CT-derived tracheal lumen eccentricity and clinical outcomes in COPD.
MethodsWe analyzed data from 8,383 participants in the multicenter COPDGene study. Tracheal lumen eccentricity ({varepsilon}) was calculated at each cross-section using the major and minor axes lengths and deriving final value using the arithmetic mean across all tracheal slices, where {varepsilon} = 0 represents a circle and {varepsilon} > 0 indicates an ellipse. Baseline assessments included spirometry measurements, 6-minute walk distance (6MWD), St. Georges Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) dyspnea score. Longitudinal assessments included annualized lung function change and all-cause mortality. Multivariable models were used to evaluate associations between tracheal eccentricity and clinical outcomes.
ResultsTracheal eccentricity increased with severity of airflow obstruction (0.60{+/-}0.07, 0.61{+/-}0.07, 0.62{+/-}0.07, 0.64{+/-}0.08, and 0.64{+/-}0.08 in GOLD stages 0 through 4, respectively). Higher tracheal eccentricity was independently associated with lower FEV1 ({beta} = -0.30 L, 95% CI: -0.47 to -0.14, p<0.001), lower FEV1/FVC ({beta} = -0.06, 95% CI: -0.09 to -0.04, p<0.001), lower 6MWD ({beta} = -15.7 m, 95% CI: -25.2 to -6.2, p=0.001), higher SGRQ score ({beta} = 16.9, 95% CI: 11.2 to 22.5, p<0.001), higher mMRC dyspnea score ({beta} = 0.4, 95% CI: 0.1 to 0.6, p=0.007), and accelerated lung function decline ({beta} = -23.8 ml/year, 95% CI: -2.48 to -45.13, p=0.029). Increased tracheal eccentricity is associated with increased all-cause mortality (adjusted HR: 1.81 [95% CI, 1.01-3.26]; p = 0.047).
ConclusionsThese findings suggest that tracheal morphology may serve as an imaging biomarker for COPD outcomes, supported by significant associations with lower quality of life, lung function decline, and all-cause mortality.
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BibTeX
@misc{aguilera2026tracheal,
title = {{Tracheal Eccentricity is Associated with Respiratory Morbidity and Mortality in Chronic Obstructive Pulmonary Disease}},
author = {S. M. Aguilera and V. Sthanam and M. F. A. Chaudhary and A. Nakhmani and J. Reinhardt and S. P. Bhatt and S. Bodduluri},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.14.26361560},
url = {https://www.medrxiv.org/content/10.64898/2026.10.14.26361560v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - Tracheal Eccentricity is Associated with Respiratory Morbidity and Mortality in Chronic Obstructive Pulmonary Disease
AU - S. M. Aguilera
AU - V. Sthanam
AU - M. F. A. Chaudhary
AU - A. Nakhmani
AU - J. Reinhardt
AU - S. P. Bhatt
AU - S. Bodduluri
PY - 2026
DA - 2026/10/14
PB - medRxiv
DO - 10.64898/2026.10.14.26361560
UR - https://www.medrxiv.org/content/10.64898/2026.10.14.26361560v1
AB - BackgroundChronic obstructive pulmonary disease (COPD) is characterized by airway remodeling, which may affect tracheal morphology. However, the relationship between tracheal morphometry and COPD severity, quality of life, functional capacity, and mortality remains poorly understood. ObjectiveTo investigate the associations between CT-derived tracheal lumen eccentricity and clinical outcomes in COPD. MethodsWe analyzed data from 8,383 participants in the multicenter COPDGene study. Tracheal lumen eccentricity ({varepsilon}) was calculated at each cross-section using the major and minor axes lengths and deriving final value using the arithmetic mean across all tracheal slices, where {varepsilon} = 0 represents a circle and {varepsilon} > 0 indicates an ellipse. Baseline assessments included spirometry measurements, 6-minute walk distance (6MWD), St. Georges Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) dyspnea score. Longitudinal assessments included annualized lung function change and all-cause mortality. Multivariable models were used to evaluate associations between tracheal eccentricity and clinical outcomes. ResultsTracheal eccentricity increased with severity of airflow obstruction (0.60{+/-}0.07, 0.61{+/-}0.07, 0.62{+/-}0.07, 0.64{+/-}0.08, and 0.64{+/-}0.08 in GOLD stages 0 through 4, respectively). Higher tracheal eccentricity was independently associated with lower FEV1 ({beta} = -0.30 L, 95% CI: -0.47 to -0.14, p<0.001), lower FEV1/FVC ({beta} = -0.06, 95% CI: -0.09 to -0.04, p<0.001), lower 6MWD ({beta} = -15.7 m, 95% CI: -25.2 to -6.2, p=0.001), higher SGRQ score ({beta} = 16.9, 95% CI: 11.2 to 22.5, p<0.001), higher mMRC dyspnea score ({beta} = 0.4, 95% CI: 0.1 to 0.6, p=0.007), and accelerated lung function decline ({beta} = -23.8 ml/year, 95% CI: -2.48 to -45.13, p=0.029). Increased tracheal eccentricity is associated with increased all-cause mortality (adjusted HR: 1.81 [95% CI, 1.01-3.26]; p = 0.047). ConclusionsThese findings suggest that tracheal morphology may serve as an imaging biomarker for COPD outcomes, supported by significant associations with lower quality of life, lung function decline, and all-cause mortality.
ER -