心血管疾病（CVD）、肺癌（LC）和呼吸道疾病是吸烟者和以前的吸烟者进行低剂量计算机断层扫描（LDCT）进行LC筛查时的主要死亡原因。我们评估了基线LDCT中肺气肿变化的定量对长期死亡率的预测价值。在这项纵向研究中，我们使用密度测量法（体积校正下相对面积低于-950豪斯菲尔德单位）和0-3视觉刻度评估了524名参与ITALUNG试验的受试者的基线LDCT中的冠状动脉钙化（CAC）和肺气肿变化，并使用常规统计和机器学习方法分析了他们与随访13.6年后的死亡率的关联性。肺气肿变化在32.3％的受试者中存在，其中14.9％为轻度（6％≤RA950≤9％），17.4％为中度至重度（RA950> 9％）。 CAC存在于67％的受试者中（轻度为34.7％，中度至重度为32.2％）。在随访期间，81（15.4％）名受试者死亡（其中20例为LC，28例为其他癌症，15例为CVD，4例为呼吸道疾病，14例为其他疾病）。在调整年龄、性别、吸烟史和CAC后，中度至重度肺气肿与总体（OR 2.22; 95CI 1.34-3.70）和CVD（OR 3.66; 95CI 1.21-11.04）死亡率显著相关。机器学习显示，RA950是预测总体和CVD死亡的最佳单个特征。中度至重度肺气肿变化是参与LC筛查的吸烟者和以前的吸烟者长期总体和CVD死亡的独立预测因素，并应纳入个体死亡风险的后测试计算中。•密度测量法允许对进行肺癌筛查的低剂量CT检查中的肺气肿变化进行定量。•肺气肿性肺部密度变化是吸烟者和以前的吸烟者进行筛查时长期总体和心血管疾病死亡的独立预测因素。•肺气肿变化的定量应包括在个体死亡风险的后测试计算中。©2023. 作者（们）。

Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality.In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach.Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality.Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile.• Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.© 2023. The Author(s).