IS THERE ANY ASSOCIATION BETWEEN INITIAL BODY MASS INDEX AND MAJOR OUTCOMES AFTER ENDOSCOPIC LUNG VOLUME REDUCTION USING ENDOBRONCHIAL VALVE PLACEMENT?

Abstract

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Body mass index (BMI) is has a higher risk of all-cause mortality. In chronic obstructive pulmonary disease (COPD) BMI is significantly lower in emphysema. COPD patients with BMI of <21.75 kg/m2 has a higher risk of death. Endoscopic lung volume reduction (ELVR) using endobronchial valve placement (EBV) is an innovative treatment for severe emphysema with optimal medical therapy. Associations between low BMI and outcomes after ELVR are not well-studied yet. We wanted to explore relations between initial BMI and changes in major outcomes after ELVR in patients with heterogeneous severe emphysema. METHODS: Data were collected at Thoraxklinik University of Heidelberg, Germany. Demography (age, gender, pack-year index, pulmonary function test); procedure (number of EBV, target lobe), changes after ELVR and complications were recorded. Group 1 and group 2 were created according to baseline BMI (G1>21kg/m2; G2< 0.005). Outcomes were the following: changes (d) in forced expiratory volume (dFEV1, % and ml), residual volume (dRV, % and ml), distance during 6-minute walking test (6MWD, m), Modified Medical Research Council dyspnea score (MMRC) and BODE index after treatment. Quantitative data was evaluated with non-parametric test (U-Mann Whitney) and qualitative data was evaluated with Fisher-exact test. Linear regression model was performed to explore baseline BMI and changes in BMI (dBMI) after ELVR (p-value < 0.005). RESULTS: 82 patients were included (G1= 63) and (G2 = 18). Average age was 62.5 years (28-81). Mean BMI in group 1 was 25.59 (21.54-35.6) compared to 19.54 (16.99-20.83) in G2. After treatment, mean change in BMI was -4.28 kg (-38, +48) and G2 reported an improvement of +8.82 kg (-25, +39) (p<0.006), BMI decreased 1.14 kg/m2 (-12.0, +13.4) in G1 and improved +4.389 kg/m2 (-2.7, +15) in G2 (p<0.0001). We found a statistical tendency between change in FEV1 (%) +3.80 in G2 (-4.2, +20.9) compared to +1.2 in G1 (-17.8, +10). In G1 d6MWD was +42.52 mts (-130, +318) and G2 +19.4 mts (-305, +250) (p=0.840). In G1 dMMRC was -0.30 pts (-3, +3), in G2 -0.066 pts (-4, +4) (p=0.272). In G1 dBODE was -0.62 pts (-6, +5), in G2 -0.833 pts (-5, +4) (p= 0.711). Linear regression analysis found an R2 value of 0.3786 in change of BMI (p<0.0001); an R2 value of 0.239 in change of weight (kg) (p<0.0001). In G2, 38.9% of patients had complications, in G1 26.98% (p=0.23). CONCLUSIONS: Baseline BMI is relevant in order to select candidates to ELVR using EBV. In patients with BMI < 21kg/m2, ELVR is associated with increased BMI and weight after treatment. We found correlation between initial BMI, change in BMI and weight after ELVR. CLINICAL IMPLICATIONS: These findings suggest a potential nutritional benefit in this population. The association between BMI and long-term outcomes should be further studied. DISCLOSURES: No relevant relationships by Sebastian Fernandez-Bussy, source=Web Response No relevant relationships by Daniela Gompelmann, source=Web Response Advisory Committee Member relationship with Pulmonx Please note: $1001 - $5000 Added 03/15/2019 by Felix Herth, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Spiration Please note: $1001 - $5000 Added 03/15/2019 by Felix Herth, source=Web Response, value=Consulting fee No relevant relationships by Anna Kornafeld, source=Web Response No relevant relationships by Gonzalo Labarca, source=Web Response