A Multicenter Study of COPD and Cognitive Impairment: Unraveling the Interplay of Quantitative CT, Lung Function, HIF-1α, and Clinical Variables
Bibliographic record
Abstract
Yopi Simargi,1– 3 Yuda Turana,4 Aziza Ghanie Icksan,5 Alida Roswita Harahap,1 Kristiana Siste,6,7 Muchtaruddin Mansyur,8 Triya Damayanti,9,10 Maryastuti Maryastuti,11 Vininta Fazharyasti,12 Indah Puspita Dewi,13,14 Yetty Ramli,15,16 Marcel Prasetyo,17,18 Cleopas Martin Rumende19,20 1Doctoral Program in Medical Science, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 2Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia; 3Department of Radiology, Atma Jaya Hospital, Jakarta, Indonesia; 4Department of Neurology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia; 5Department of Radiology, Prima Indonesia University, Medan, Indonesia; 6Department of Psychiatry, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 7Department of Psychiatry, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 8Department of Community, Occupational and Family Medicine, Faculty of Medicine, University of Indonesia, Depok, Indonesia; 9Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 10Department of Pulmonology and Respiratory Medicine, National Respiratory Center Persahabatan Hospital, Jakarta, Indonesia; 11Department of Radiology, National Respiratory Center Persahabatan Hospital, Jakarta, Indonesia; 12Department of Radiology, Gatot Soebroto Army Hospital, Jakarta, Indonesia; 13Department of Radiology, Faculty of Medicine and Health, University of Muhammadiyah Jakarta, Jakarta, Indonesia; 14Department of Radiology, Jakarta Islamic Hospital Cempaka Putih, Jakarta, Indonesia; 15Department of Neurology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 16Department Neurology, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 17Department of Radiology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 18Department of Radiology, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 19Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 20Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital, Jakarta, IndonesiaCorrespondence: Yopi Simargi, Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, RT.21/RW.8, Penjaringan, Kec. Penjaringan, Jkt Utara, Daerah Khusus Ibukota, Jakarta, 14440, Email yopi.simargi@atmajaya.ac.idPurpose: The exact link between cognitive impairment (CI) and chronic obstructive pulmonary disease (COPD) is still limited. Thus, we aim to find the relationship and interaction of quantitative CT (QCT), lung function, HIF-1α, and clinical factors with the development of CI among COPD patients.Patients and Methods: A cross-sectional multicentre study was conducted from January 2022 to December 2023. We collected clinical data, spirometry, CT images, and venous blood samples from 114 COPD participants. Cognitive impairment assessment using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) with a cutoff value 26. The QCT analysis consists of lung density, airway wall thickness, pulmonary artery-to-aorta ratio (PA:A), and pectoralis muscles using 3D Slicer software. Serum HIF-1α analysis was performed using ELISA.Results: We found significant differences between %LAA− 950, age, COPD duration, BMI, FEV1 pp, and FEV1/FVC among GOLD grades I–IV. Only education duration was found to correlate with CI (r = 0.40; p < 0.001). We found no significant difference in HIF-1α among GOLD grades (p = 0.149) and no correlation between HIF-1α and CI (p = 0.105). From multiple linear regression, we observed that the MoCA-Ina score was influenced mainly by %LAA− 950 (p = 0.02) and education duration (p = 0.01). The path analysis model showed both %LAA and education duration directly and indirectly through FEV1 pp contributing to CI.Conclusion: We conclude that the utilization of QCT parameters is beneficial as it can identify abnormalities and contribute to the development of CI, indicating its potential utility in clinical decision-making. The MoCA-Ina score in COPD is mainly affected by %LAA− 950 and education duration. Contrary to expectations, this study concludes that HIF-1α does not affect CI among COPD patients.Keywords: chronic obstructive pulmonary disease, cognitive impairment, emphysema lung, hypoxia inducible factor
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".