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Individualised risk in patients undergoing lung volume reduction surgery (LVRS): The Glenfield BFG Score

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posted on 2017-02-22, 14:55 authored by Neil J. Greening, Paul Vaughn, Inger Oey, Michael C. Steiner, Mike D. Morgan, Sridhar Rathinam, David A. Waller
Introduction: LVRS has been shown to be beneficial in patients with COPD but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score after LVRS. Methods: This was a cohort study of patients undergoing LVRS. Factors independently predicting 90 day mortality and a risk prediction score were identified. Reliability of the score was tested using area under receiver operator characteristic curve (AUROC). Results: 237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were; BMI <18.5 kg/m2(OR 2.83, p=0.059), FEV1<0.71L (OR 5.47, p=0.011) and TLCO<20% (OR 5.56, p=0.031). A risk score was calculated and a total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. 46% of patients were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90 day mortality in this cohort was 0.84. Conclusion: It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients.

Funding

Dr Greening is a National Institute for Health Research (NIHR) funded Clinical Lecturer. The study took place at the University Hospitals of Leicester NHS Trust. Support was also provided by the NIHR Leicester Respiratory Biomedical Research Unit.

History

Citation

European Respiratory Journal, 2017, 49(6)

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Infection, Immunity and Inflammation

Version

  • AM (Accepted Manuscript)

Published in

European Respiratory Journal

Publisher

European Respiratory Society: ERJ

issn

0903-1936

eissn

1399-3003

Acceptance date

2017-02-19

Copyright date

2017

Available date

2018-12-01

Publisher version

http://erj.ersjournals.com/content/49/6/1601766

Notes

The file associated with this record is under embargo until 18 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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