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Zhang XH, Han MF, Teng XB, Shi JF, Xu XL. Combined Inflammatory Markers for Predicting Acute Exacerbations in Chronic Obstructive Pulmonary Disease With Respiratory Failure. J Inflamm Res 2025; 18:2513-2520. [PMID: 39991663 PMCID: PMC11847442 DOI: 10.2147/jir.s508048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 01/30/2025] [Indexed: 02/25/2025] Open
Abstract
Objective This study aimed to assess the predictive value of the neutrophil-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and serum amyloid A (SAA) in predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure (RF). Methods A retrospective study was conducted on 198 patients with AECOPD in the Respiratory Department of No. 2 People's Hospital of Fuyang City from December 2022 to May 2023. Patients were categorized into two groups: an experimental group with the presence of RF (n = 70) and a control group with no RF present (n = 128). Baseline characteristics and inflammatory marker levels were compared between the two groups, and their impact on the risk of readmission within one year was analyzed to assess the predictive value of NLR, CAR, and SAA in patients with AECOPD and RF. Results The experimental group exhibited significantly higher levels of white blood cells, neutrophils, C-reactive protein (CRP), SAA, NLR, and CAR compared to the control group. Additionally, the experimental group had a higher one-year readmission rate, with statistically significant differences. The areas under the receiver operating characteristic (ROC) curve for NLR, CAR, and SAA in predicting AECOPD with RF were 0.705, 0.659, and 0.656, respectively. When combined, the ROC area under the curve for these three markers increased to 0.717, which was statistically significant. Conclusion The combined assessment of NLR, CAR, and SAA offers a reliable reflection of systemic inflammation and holds predictive value for AECOPD with RF.
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Affiliation(s)
- Xiao-Hua Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui, 236015, People’s Republic of China
| | - Ming-Feng Han
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui, 236015, People’s Republic of China
| | - Xiao-Bao Teng
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui, 236015, People’s Republic of China
| | - Jing-Feng Shi
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui, 236015, People’s Republic of China
| | - Xiao-Ling Xu
- Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
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2
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Justel Enríquez A, Rabat-Restrepo JM, Vilchez-López FJ, Tenorio-Jiménez C, García-Almeida JM, Irles Rocamora JA, Pereira-Cunill JL, Martínez Ramírez MJ, Molina-Puerta MJ, Molina Soria JB, Rebollo-Pérez MI, Olveira G, García-Luna PP. Practical Guidelines by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) on Nutritional Management of Patients with Chronic Obstructive Pulmonary Disease: A Review. Nutrients 2024; 16:3105. [PMID: 39339705 PMCID: PMC11434837 DOI: 10.3390/nu16183105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Malnutrition is common in chronic obstructive pulmonary disease (COPD) patients and is associated with worse lung function and greater severity. This review by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) addresses the nutritional management of adult COPD patients, focusing on Morphofunctional Nutritional Assessment and intervention in clinical practice. A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, followed by critical appraisal based on Scottish Intercollegiate Guidelines Network (SIGN) guidelines. Recommendations were graded according to the European Society for Clinical Nutrition and Metabolism (ESPEN) system. The results were discussed among GARIN members, with consensus determined using a Likert scale. A total of 24 recommendations were made: 2(A), 6(B), 2(O), and 14(GPP). Consensus exceeded 90% for 17 recommendations and was 75-90% for 7. The care of COPD patients is approached from a nutritional perspective, emphasizing nutritional screening, morphofunctional assessment, and food intake in early disease stages. Nutritional interventions include dietary advice, recommendations on food group intake, and the impact of specialized nutritional treatment, particularly oral nutritional supplements. Other critical aspects, such as physical activity and quality of life, are also analyzed. These recommendations provide practical guidance for managing COPD patients nutritionally in clinical practice.
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Affiliation(s)
- Alicia Justel Enríquez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de la Princesa, 28006 Madrid, Spain
| | - Juana M. Rabat-Restrepo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
| | | | - Carmen Tenorio-Jiménez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain
| | - José M. García-Almeida
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga/Plataforma Bionand, 29010 Málaga, Spain
| | - José-Antonio Irles Rocamora
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- UGC Endocrinología y Nutrición, Hospital Universitario Valme, 41014 Sevilla, Spain
| | - José L. Pereira-Cunill
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBIS), 41007 Sevilla, Spain
| | - María J. Martínez Ramírez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, 23007 Jaén, Spain
- Facultad de Medicina, Universidad de Jaén, 23071 Jaén, Spain
| | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | - María I. Rebollo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain
| | - Gabriel Olveira
- Instituto de Investigación Biomédica de Málaga/Plataforma Bionand, 29010 Málaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | - Pedro P. García-Luna
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBIS), 41007 Sevilla, Spain
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Liu Z, Sun Z, Hu H, Yin Y, Zuo B. Development and validation of a prospective study to predict the risk of readmission within 365 days of respiratory failure: based on a random survival forest algorithm combined with COX regression modeling. BMC Pulm Med 2024; 24:82. [PMID: 38355552 PMCID: PMC10865688 DOI: 10.1186/s12890-024-02862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND There is a need to develop and validate a widely applicable nomogram for predicting readmission of respiratory failure patients within 365 days. METHODS We recruited patients with respiratory failure at the First People's Hospital of Yancheng and the People's Hospital of Jiangsu. We used the least absolute shrinkage and selection operator regression to select significant features for multivariate Cox proportional hazard analysis. The Random Survival Forest algorithm was employed to construct a model for the variables that obtained a coefficient of 0 following LASSO regression, and subsequently determine the prediction score. Independent risk factors and the score were used to develop a multivariate COX regression for creating the line graph. We used the Harrell concordance index to quantify the predictive accuracy and the receiver operating characteristic curve to evaluate model performance. Additionally, we used decision curve analysiso assess clinical usefulness. RESULTS The LASSO regression and multivariate Cox regression were used to screen hemoglobin, diabetes and pneumonia as risk variables combined with Score to develop a column chart model. The C index is 0.927 in the development queue, 0.924 in the internal validation queue, and 0.922 in the external validation queue. At the same time, the predictive model also showed excellent calibration and higher clinical value. CONCLUSIONS A nomogram predicting readmission of patients with respiratory failure within 365 days based on three independent risk factors and a jointly developed random survival forest algorithm has been developed and validated. This improves the accuracy of predicting patient readmission and provides practical information for individualized treatment decisions.
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Affiliation(s)
- Zhongxiang Liu
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Zhixiao Sun
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Hang Hu
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China
| | - Yuan Yin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical Univesity, Nanjing, 210029, China
| | - Bingqing Zuo
- Department of Pulmonary and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224006, China.
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Song Q, Zhou A, Lin L, Li X, Cheng W, Liu C, Peng Y, Zeng Y, Yi R, Liu Y, Li X, Chen Y, Cai S, Chen P. The clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease with low body mass index. Front Pharmacol 2023; 14:1131614. [PMID: 37521460 PMCID: PMC10372446 DOI: 10.3389/fphar.2023.1131614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Background: This study aimed to analyze the clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease (COPD) with low body mass index (BMI). Methods: In this cross-sectional study, we enrolled patients with stable COPD from the database setup by the Second Xiangya Hospital of Central South University. We classified the patients into three groups based on BMI: low-BMI (<18.5 kg/m2), normal-BMI (≥18.5 and <24.0 kg/m2), and high-BMI (≥24 kg/m2) groups. We defined clinically important deterioration (CID) as a COPD Assessment Test (CAT) score increase of ≥2 and minimum clinically important difference (MCID) as a CAT score decrease of ≥2 during 6 months of follow-up. We recorded the number of exacerbations and mortality during 1 year of follow-up. Results: A total of 910 COPD patients were included with 144 (15.8%) patients in low-BMI, 475 (52.2%) in normal-BMI, and 291 (32.0%) in high-BMI groups. Patients with low BMI had worse pulmonary function, higher symptom scores, and exacerbations in the past year compared with normal- and high-BMI groups (p < 0.05). Logistic regression analysis revealed that age, Global Initiative for Chronic Obstructive Lung Disease grades 3 and 4, and hospitalizations in the past year were independent risk factors for patients with low BMI (p < 0.05). After 1 year of follow-up, patients with low BMI had higher mortality and number of hospitalizations. Patients with low BMI were more likely to attain CID and less likely to attain MCID compared with patients with high BMI (p < 0.05). In addition, patients with low BMI treated with long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA) and LABA+LAMA+inhaled corticosteroid (ICS) were more likely to attain MCID than those treated with LABA+ICS and LAMA (p < 0.05). Conclusion: COPD patients with low BMI had worse pulmonary function, higher symptom scores, and higher risk of future hospitalizations and mortality and were less likely to attain MCID and more likely to attain CID. It is worth noting that patients with low BMI treated with LABA+LAMA and LABA+LAMA+ICS were more likely to attain MCID than those treated with LABA+ICS and LAMA.
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Affiliation(s)
- Qing Song
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Aiyuan Zhou
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Lin
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xueshan Li
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Wei Cheng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Cong Liu
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yating Peng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yuqin Zeng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Rong Yi
- Department of Pulmonary and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Yi Liu
- Department of Pulmonary and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Xin Li
- Division 4 of Occupational Diseases, Hunan Prevention and Treatment Institute for Occupational Diseases, Changsha, Hunan, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr 2023; 42:848-858. [PMID: 37084471 DOI: 10.1016/j.clnu.2023.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk. RESULTS Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition. CONCLUSION Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Ye Lu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
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Tramontano A, Palange P. Nutritional State and COPD: Effects on Dyspnoea and Exercise Tolerance. Nutrients 2023; 15:nu15071786. [PMID: 37049625 PMCID: PMC10096658 DOI: 10.3390/nu15071786] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a disease that is spreading worldwide and is responsible for a huge number of deaths annually. It is characterized by progressive and often irreversible airflow obstruction, with a heterogeneous clinical manifestation based on disease severity. Along with pulmonary impairment, COPD patients display different grades of malnutrition that can be linked to a worsening of respiratory function and to a negative prognosis. Nutritional impairment seems to be related to a reduced exercise tolerance and to dyspnoea becoming a major determinant in patient-perceived quality of life. Many strategies have been proposed to limit the effects of malnutrition on disease progression, but there are still limited data available to determine which of them is the best option to manage COPD patients. The purpose of this review is to highlight the main aspects of COPD-related malnutrition and to underline the importance of poor nutritional state on muscle energetics, exercise tolerance and dyspnoea.
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Affiliation(s)
- Angela Tramontano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Respiratory and Critical Care, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Respiratory and Critical Care, Policlinico Umberto I Hospital, 00161 Rome, Italy
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Stephenson SS, Guligowska A, Cieślak-Skubel A, Wójcik A, Kravchenko G, Kostka T, Sołtysik BK. The Relationship between Nutritional Risk and the Most Common Chronic Diseases in Hospitalized Geriatric Population from Central Poland. Nutrients 2023; 15:nu15071612. [PMID: 37049453 PMCID: PMC10096810 DOI: 10.3390/nu15071612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this study was to assess the relationship between Nutrition Risk Screening 2002 (NRS-2002) and the prevalence of concomitant chronic diseases among hospitalized older adults. This study included 2122 consecutively hospitalized older participants with an average age of 82 years. The criteria to participate were the ability to communicate and give consent. In multivariate design, the prevalence of nutritional risk with at least 3 points in the NRS-2002 score was associated with the presence of stroke, atrial fibrillation, dementia and pressure ulcers. Patients with arterial hypertension, lipid disorders, osteoarthritis and urine incontinence had a significantly lower (better) NRS-2002 score. The explanation of the inverse relationship between some disorders and nutritional risk may be their occurrence in relatively earlier age and the relationship with body mass index. In conclusion, the study revealed which medical conditions coexist with the increased nutritional risk in a “real-world” hospitalized geriatric population. The hospital admission of an older subject with stroke, atrial fibrillation, dementia or pressure ulcers should primarily draw attention to the nutritional risk of the patient.
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Zhao X, Su R, Hu R, Chen Y, Xu X, Yuan Y, Zhang J, Zhang W, Yang Y, Chen M, Li D, Wu B, Huang D, Wu D. Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study. BMC Geriatr 2023; 23:89. [PMID: 36774462 PMCID: PMC9921248 DOI: 10.1186/s12877-023-03784-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Sarcopenia is a geriatric syndrome with progressive loss of skeletal muscle mass and function and has a negative impact on clinical outcomes associated with chronic obstructive pulmonary disease (COPD). Recently, the sarcopenia index (SI) was developed as a surrogate marker of sarcopenia based upon the serum creatinine to cystatin C ratio. We aimed to assess the value of SI for predicting clinically important outcomes among elderly patients with acute exacerbation of COPD (AECOPD). METHODS This cross-sectional study included elderly patients with AECOPD in China from 2017 to 2021. Clinical data were collected from medical records, and serum creatinine and cystatin C were measured. Outcomes included respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality. Binary logistic regression was used to analyze the association between SI and clinical outcomes. RESULTS A total of 306 patients (260 men, 46 women, age range 60-88 years) were enrolled in this study. Among the total patients, the incidence of respiratory failure and severe pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was still independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13-0.56, P < 0.05). In subgroup analysis, the incidence of respiratory failure was negatively associated with SI values in groups with both frequent exacerbation and non-frequent exacerbation. After adjustment for potential confounders, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06-0.64 and OR: 0.31, 95% CI: 0.11-0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, invasive mechanical ventilation, and mortality in all groups. CONCLUSION The SI based on serum creatinine and cystatin C can predict respiratory failure in patients with AECOPD and either frequent or infrequent exacerbations. This indicator provides a convenient tool for clinicians when managing patients with AECOPD in daily clinical practice.
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Affiliation(s)
- Xuanna Zhao
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ruoxin Su
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Rongwei Hu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yujuan Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoyong Xu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yalian Yuan
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinhong Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wenchao Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yu Yang
- grid.410560.60000 0004 1760 3078Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Min Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongming Li
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Wu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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Ling M, Huiyin L, Shanglin C, Haiming L, Zhanyi D, Shuchun W, Meng B, Murong L. Relationship between human serum albumin and in-hospital mortality in critical care patients with chronic obstructive pulmonary disease. Front Med (Lausanne) 2023; 10:1109910. [PMID: 37181348 PMCID: PMC10174316 DOI: 10.3389/fmed.2023.1109910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background The relationship between human serum albumin levels and the prognosis of critical care patients with chronic obstructive pulmonary disease (COPD) remains controversial. Objective To investigate the relationship between serum albumin levels and in-hospital mortality in critical care patients with COPD. METHODS: This study used a retrospective observational cohort from the Medical Information in Intensive Care database (MIMIC-IV) in the United States. Multivariate Cox regression analysis was used to assess the relationship between serum albumin levels and in-hospital mortality. A restricted cubic spline line was also used to explore nonlinear relationship. Results A total of 3,398 critical care patients with COPD were included. The overall in-hospital mortality was 12.4%. We found a negative relationship between human serum albumin and in-hospital mortality (HR = 0.97, 95% CI 0.96-0.99, p = 0.002). Conclusion In critical care patients with COPD, there was a negative association between human serum albumin and in-hospital mortality.
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Affiliation(s)
- Ma Ling
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Li Huiyin
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Shanglin
- Department of Laboratory, The Fifth People’s Hospital of Panyu District, Guangzhou, China
| | - Li Haiming
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Di Zhanyi
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Wang Shuchun
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Bai Meng
- Department of Computer Center, Fujian Provincial Maternity Hospital, Fuzhou, Fujian, China
- *Correspondence: Bai Meng,
| | - Lu Murong
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Lu Murong,
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Bernardes S, Teixeira PJZ, Silva FM. Association of reduced BMI, length of hospital stay, mortality, and malnutrition diagnosis in patients with acute exacerbation COPD: A secondary analysis of a cohort study. JPEN J Parenter Enteral Nutr 2023; 47:101-108. [PMID: 35511699 DOI: 10.1002/jpen.2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Body mass index (BMI) presents prognostic value in chronic obstructive pulmonary disease (COPD), and despite its limitations in capturing malnutrition, its use is common to assess nutritional status. We aimed to confirm the association between BMI and in-hospital outcomes in acute exacerbation of COPD (AECOPD) and its inaccuracy in diagnosing malnutrition. METHODS We diagnosed malnutrition using the Subjective global assessment (SGA), Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), and two cutoff values for reduced BMI (age-related and ≤ 21.0). BMI accuracy was assessed using the area under the receiver operating characteristic (AUC-ROC) curve and SGA and AND-ASPEN as references. We evaluated in-hospital mortality and hospital stay outcomes and constructed logistic regression models. RESULTS The median hospital stay was 11 (7-18) days, and 7.5% of patients died. Malnutrition prevalence according to BMI, SGA, and AND-ASPEN was 21.4% (mean of both cutoff values), 50%, and 54%, respectively. Reduced BMI presented low agreement (κ = 0.315-0.383) and unsatisfactory accuracy (AUC-ROC curve = 0.333-0.679) with reference methods for malnutrition diagnosis. Age-related reduced BMI (odds ratio [OR] = 2.11; 95% CI, 1.10-4.04) and BMI ≤ 21.0 (OR = 2.25; 95% CI, 1.13-4.48) were associated with hospital stays longer than the median in adjusted models, but not in-hospital mortality. CONCLUSION BMI was inaccurate in identifying malnutrition in hospitalized patients with AECOPD and was associated with hospital stays longer than ten days.
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Affiliation(s)
- Simone Bernardes
- Health Sciences Graduate Program from Federal University of Health Sciences of Porto Alegre, RS, Brazil
| | - Paulo José Zimermann Teixeira
- Pulmonary Rehabilitation Program, Hospital Pavilhão Pereira Filho, Santa Casa de Misericordia of Porto Alegre Hospital Complex, Undergraduate Medicine Program and Health Sciences Graduate Program from Federal University of Health Sciences of Porto Alegre, RS, Brazil.,Undergraduate Medicine Program and Health Sciences Graduate Program from Federal University of Health Sciences of Porto Alegre, RS, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Graduate Program from Federal University of Health Sciences of Porto Alegre, RS, Brazil
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Çelik D, Yildiz M, Çifci A. Serum osmolarity does not predict mortality in patients with respiratory failure. Medicine (Baltimore) 2022; 101:e28840. [PMID: 35147129 PMCID: PMC8830864 DOI: 10.1097/md.0000000000028840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to determine the parameters that affect mortality in pulmonary intensive care units that are faster and inexpensive to determine than existing scoring systems. The relationship between serum osmolarity and prognosis was demonstrated for predialysis patients, in acute pulmonary embolism, heart failure, acute coronary syndrome, myocardial infarction, and acute spontaneous intracerebral hemorrhage in the literature. We hypothesized that serum osmolarity, which is routinely evaluated, may have prognostic significance in patients with respiratory failure.This study comprised 449 patients treated in the Pulmonary Intensive Care Clinic (PICU) of our hospital between January 1, 2020, and December 31, 2020. The modified Charlson Comorbidity Index (mCCI), Acute Physiology and Chronic Health Assessment (APACHE II), Sequential Organ Failure Evaluation Score (SOFA), Nutrition Risk Screening 2002 (NRS-2002), and hospitalization serum osmolarity levels were measured.Of the 449 patients included in the study, 65% (n = 292) were female and the mean age of all patients was 69.86 ± 1.72 years. About 83.1% (n = 373) of the patients included in the study were discharged with good recovery. About 4.9% (n = 22) were transferred to the ward because their intensive care needs were over. About 6.9% (n = 31) were transferred to the tertiary intensive care unit after their status deteriorated. About 5.1% (n = 23) died in the PICU. In the mortality group, APACHE II (P = .005), mCCI (P < .001), NRS-2002 total score (P < .001), and SOFA score (P < .001) were significantly higher. There was no statistically significant difference between the groups in terms of serum osmolarity levels.Although we could not determine serum osmolarity as a practical method to predict patient prognosis in this study, we assume that our results will guide future studies on this subject.
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Affiliation(s)
- Deniz Çelik
- Alanya Alaaddin Keykubat University, Faculty of Medicine, Department of Pulmonology, Alanya, Antalya, Turkey
| | - Murat Yildiz
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
| | - Ayşe Çifci
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
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YILDIZ M, ÇELİK D. The relationship between the nutritional status, body-mass index of patients with chronic obstructive pulmonary disease and respiratory failure and their 1-year survival. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Zeng X, Yang H, Yang Y, Gu X, Ma X, Zhu T. Associations of Clinical Characteristics and Intestinal Flora Imbalance in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients and the Construction of an Early Warning Model. Int J Chron Obstruct Pulmon Dis 2021; 16:3417-3428. [PMID: 34955637 PMCID: PMC8694711 DOI: 10.2147/copd.s330976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Establish a simple predictive model and scoring rule that is suitable for clinical medical staff in respiratory departments to assess intestinal flora imbalance occurrence in stable chronic obstructive pulmonary disease (COPD) patients. Methods From January 1, 2019, to December 31, 2020, COPD patients (195 cases) – who attended the Outpatient Department, Respiratory and Critical Care, Yixing Hospital, Jiangsu University – were enrolled in a cross-sectional study. Based on stool examination results, patients were divided into experimental (41 cases) and control (154 cases) groups. Single-factor and logistic regression analyses were performed with the baseline data of the two groups to obtain a new predictive model, which was further simplified. Results Five predictive factors composed the model: body mass index (BMI), serum albumin (ALB), Charlson’s Comorbidity Index (CCI), gastrointestinal symptom score (GSRs), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The model to predict intestinal flora imbalance in stable COPD patients had an area under the ROC curve (AUC) of 0.953 [95% CI (0.924, 0.982)]. After simplifying the scoring rules, the AUC was 0.767 [95% CI (0.676, 0.858)]. Conclusion In the current study, we obtained a model that could effectively predict intestinal flora imbalance risk in stable COPD patients, being suitable for implementation in early treatments to improve the prognosis. Moreover, all indicators can be easily and simply obtained.
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Affiliation(s)
- Xuetao Zeng
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Hongfeng Yang
- Department of Critical Medicine,The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Yan Yang
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Xinnan Gu
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Xiuqin Ma
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Taofeng Zhu
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
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[Nutritional risk and clinical outcomes in patients diagnosed with COVID-19 in a high-complexity hospital network]. NUTR HOSP 2021; 39:93-100. [PMID: 34756055 DOI: 10.20960/nh.03738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION the identification of nutritional risk at hospital admission is important to establish timely interventions in the COVID-19 patient care cycle, due to a high risk of it being associated with complications. OBJECTIVE to determine the association between the level of nutritional risk upon admission and in-hospital mortality at 28 days in patients diagnosed with COVID-19 treated between March and October 2020 in two hospital institutions in Colombia. METHODS a retrospective, observational study. Hospitalized patients with a diagnosis of COVID-19 were included and assessed by the Nutrition Service using the nutritional risk identification in emergencies scale, adapted from the NRS 2002 scale. In-hospital mortality at 28 days was analyzed as the primary endpoint, and hospital stay, admission to Intensive Care Unit (ICU), and requirement for mechanical ventilation as secondary endpoints. RESULTS a total of 1230 patients were included, with a mean age of 65.43 ± 15.90 years, mainly men (57.1 %, n = 702). A high nutritional risk (≥ 2 points) was identified in 74.3 % (n = 914). Patients with a high nutritional risk had a greater probability of in-hospital death at 28 days (HRadj: 1.64; 95 % CI: 1.11-2.44), and a greater risk of requiring mechanical ventilation (OR = 1.78; 95 % CI: 1.11-2.86) or ICU admission (OR = 1.478; 95 % CI: 1.05-2.09), as well as hospital stay longer than 7 days (OR = 1.91; 95 % CI: 1.47-2.48). CONCLUSIONS patients with a diagnosis of COVID-19 at high nutritional risk had a significantly higher in-hospital mortality at 28 days and a higher probability of requiring mechanical ventilation, ICU admission, and prolonged hospital stay.
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AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity. Eur J Clin Nutr 2021; 76:685-692. [PMID: 34702965 DOI: 10.1038/s41430-021-01025-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients. SUBJECTS/METHODS Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated. RESULTS In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes. CONCLUSIONS The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.
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Efthymiou A, Hersberger L, Reber E, Schönenberger KA, Kägi-Braun N, Tribolet P, Mueller B, Schuetz P, Stanga Z. Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial. Clin Nutr 2021; 40:1546-1554. [PMID: 33743290 DOI: 10.1016/j.clnu.2021.02.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients. METHODS We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes. RESULTS We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk. CONCLUSION Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.
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Affiliation(s)
- Andriana Efthymiou
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emilie Reber
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | | | | | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Miličević T, Kolčić I, Đogaš T, Živković PM, Radman M, Radić J. Nutritional Status and Indicators of 2-Year Mortality and Re-Hospitalizations: Experience from the Internal Clinic Departments in Tertiary Hospital in Croatia. Nutrients 2020; 13:nu13010068. [PMID: 33379274 PMCID: PMC7824225 DOI: 10.3390/nu13010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to provide insight into nutritional and clinical indicators of malnutrition risk and their influence on two-year mortality and re-hospitalization rate among patients hospitalized in internal clinic departments in the tertiary hospital in Croatia. Initially, data on 346 participants were obtained, while 218 of them where followed-up two years later. At baseline, the majority of participants were old and polymorbid (62.1% suffered from arterial hypertension, 29.5% from cancer, and 29.2% from diabetes). Even apparently presenting with satisfying anthropometric indices, 38.4% of them were at-risk for malnutrition when screened with the Nutritional Risk Screening-2002 (NRS-2002) questionnaire (NRS-2002 ≥ 3). More importantly, only 15.3% of all participants were prescribed an oral nutritional supplement during hospitalization. Those that were at-risk for malnutrition suffered significantly more often from cancer (54.9% vs. 20.6%; p < 0.001) and died more often in the follow-up period (42.7% vs. 23.5%; p < 0.003). Their anthropometric indices were generally normal and contradictory 46.3% were overweight and obese (body mass index (BMI) > 25 kg/m2). Only 36.6% of nutritionally endangered participants used an oral supplement in the follow-up period. NRS-2002 ≥ 3 correlated with anthropometric indices, glomerular filtration rate, age, and length of the initial hospital stay. Unlike other studies, NRS-2002 ≥ 3 was not an independent predictor of mortality and re-hospitalizations; other clinical, rather than nutritional parameters proved to be better predictors. Patients in our hospital are neither adequately nutritionally assessed nor managed. There is an urgent need to develop strategies to prevent, identify, and treat malnutrition in our hospital and post-discharge.
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Affiliation(s)
- Tanja Miličević
- Department of Endocrinology and Diabetology, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia; (T.M.); (M.R.)
| | - Ivana Kolčić
- Department of Public Health, University of Split School of Medicine, Šoltanska 2, 21 000 Split, Croatia;
| | - Tina Đogaš
- Department of Nephrology and Dialysis, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia;
| | - Piero Marin Živković
- Department of Gastroenterology, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia;
| | - Maja Radman
- Department of Endocrinology and Diabetology, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia; (T.M.); (M.R.)
- Department of Internal Medicine, University of Split School of Medicine, Šoltanska 2, 21 000 Split, Croatia
| | - Josipa Radić
- Department of Nephrology and Dialysis, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia;
- Department of Internal Medicine, University of Split School of Medicine, Šoltanska 2, 21 000 Split, Croatia
- Correspondence: ; Tel.: +385-91-502-7100
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Chohan K, Park J, Dales S, Varughese R, Wickerson L, Singer LG, Stewart B, Rozenberg D. Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index. Transplant Direct 2020; 6:e574. [PMID: 32766429 PMCID: PMC7339342 DOI: 10.1097/txd.0000000000001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition in lung transplant (LTx) candidates is an important risk factor for adverse outcomes. We sought to evaluate the Nutritional Risk Index (NRI) in LTx candidates, a validated measure of malnutrition risk in chronic disease. We aimed to characterize malnutrition risk using NRI, evaluate change in body weight between nutritional risk groups, and assess association of malnutrition risk with pretransplant and posttransplant outcomes. METHODS Retrospective, single-center cohort study of LTx candidates (2014-2015) evaluated by a dietitian before listing. Nutritional parameters, weight change pretransplant and posttransplant, and clinical outcomes were abstracted up to 1-year posttransplant. NRI was calculated as follows: (1.519 × albumin) + (41.7 × current weight/ideal weight) with high malnutrition risk defined as the lowest quartile of NRI for cystic fibrosis (CF) and non-CF patients. RESULTS The cohort comprises 247 LTx candidates (57% male; median age 59 y; non-CF 88%). Non-CF candidates had a greater mean NRI compared with CF patients (109 ± 11 versus 95 ± 12; P < 0.0001). 86% with high malnutrition risk maintained/gained weight (≥5%) pretransplant. In 196 LTx recipients, malnutrition risk was not associated with hospital stay, discharge disposition, or 1-year mortality. The median percent weight gain for LTx recipients in the first year was 10.5% (4.0-20.1), with high malnutrition risk recipients having comparable or greater weight gain to the low-risk group (mean difference for non CF: 6.8%; P = 0.02 and CF: -3.8%; P = 0.65). CONCLUSIONS Malnutrition risk assessed with NRI was not prognostic of posttransplant outcomes in this retrospective cohort. LTx candidates with high malnutrition risk were able to maintain their weight pretransplant and demonstrated considerable weight gain in the first-year posttransplant.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeff Park
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Dales
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Rhea Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa Wickerson
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Lianne G. Singer
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Brooke Stewart
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
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Sanson G, Sadiraj M, Barbin I, Confezione C, De Matteis D, Boscutti G, Zaccari M, Zanetti M. Prediction of early- and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond. Clin Nutr 2020; 39:1092-1100. [DOI: 10.1016/j.clnu.2019.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/19/2019] [Accepted: 04/11/2019] [Indexed: 01/07/2023]
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Raad S, Smith C, Allen K. Nutrition Status and Chronic Obstructive Pulmonary Disease: Can We Move Beyond the Body Mass Index? Nutr Clin Pract 2019; 34:330-339. [DOI: 10.1002/ncp.10306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Samih Raad
- Department of Medicine; Section of Pulmonary; Critical Care and Sleep Medicine; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma USA
| | - Cheryl Smith
- Clinical Dietitian Oklahoma City VA Healthcare System; Oklahoma City Oklahoma USA
| | - Karen Allen
- Section of Pulmonary; Critical Care and Sleep Oklahoma City VA Healthcare System; Oklahoma City Oklahoma USA
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