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Association of Reduced BMI, length of hospital stay, mortality, and malnutrition diagnosis in COPD patients with acute exacerbation: A secondary analysis of a cohort study.

BACKGROUND
Body mass index (BMI) has received attention in relation to chronic obstructive pulmonary disease (COPD) given its prognostic value; despite its limitations in capturing nutritional impairments compatible with malnutrition, it is still used to assess nutritional status. This study aimed to confirm the association between BMI and in-hospital outcomes in patients with acute exacerbation of COPD (AECOPD) and its inaccuracy in diagnosing malnutrition.


METHODS
This was a secondary analysis of a prospective observational study of hospitalized AECOPD patients. Malnutrition was diagnosed 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). We assessed BMI accuracy using the area under the receiver operating characteristic (AUC-ROC) curve using SGA and AND-ASPEN as references. We evaluated in-hospital mortality and hospital stay outcomes (longer or shorter than the median) and constructed logistic regression models.


RESULTS
A total of 241 patients were analyzed where 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 with SGA and AND-ASPEN for malnutrition diagnosis (kappa = 0.315-0.383) and unsatisfactory accuracy (AUC-ROC curve = 0.333-0.679). Age-related reduced BMI (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 positively associated with hospital stays longer than 10 days. This article is protected by copyright. All rights reserved.