BODE Index before and after LVRS is associated with long term survival in a post-NETT cohort

Abstract

The BODE Index is a composite score that predicts risk of death in patients with COPD. Lung Volume Reduction Surgery (LVRS) provides a survival advantage for select patients, as shown in the National Emphysema Treatment Trial (NETT). LVRS improves BODE score, and prior to NETT postoperative BODE was shown to correlate with survival. This finding has not yet been replicated post-NETT. Aims We hypothesized that LVRS done using NETT selection criteria would reduce BODE and that pre and postoperative BODE would associate with survival. Methods Data was collected prospectively on all patients undergoing LVRS from 2004-2015. Outcomes studied were surgical mortality, BODE preoperatively, at 6 months, 1 year and 2 years, and survival at 5 years. Comparison of BODE score and their changes were assessed using two-sided t-test. Cox regression was used to evaluate impact of BODE score on the hazard rate. Results 101 patients (40% male) underwent bilateral LVRS from 2004-2015. Preoperative data showed a mean FEV 1 of 26% predicted, mean 6MWT of 375m, mean MMRC of 2.58, and mean BMI of 24.5, for a mean BODE of 5.07. After LVRS, BODE improved a mean -2.1, -1.9 and -1.4 at 6 months, 1 year and 2 years. 6 month mortality was 0%. Both preoperative BODE and BODE at 6 months had a significant effect on survival at 5 years, with a HR of 1.48 (95% CI 1.01-2.18, p=.047) and a HR of 1.69 (95% CI 1.18-2.42, p=.004). Those who later died had a significantly higher BODE 6 months post-LVRS (4.17 vs. 2.78, p=0.004). Conclusions LVRS is a safe procedure with low surgical mortality when done using NETT selection criteria. LVRS lowers BODE score, and both pre and postoperative BODE remain important predictors of survival.