Malnutrition and obesity: influence in mortality and readmissions in chronic obstructive pulmonary disease patients

Abstract

Obesity in patients hospitalised for COPD substantially reduces in-hospital mortality risk and the possibility of early re-admittance. Malnutrition is associated with an important increase in in-hospital mortality and risk of re-admittance in the 30 days following discharge.

Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…A similar role has been found in patients suffering from malnutrition (OR, 1.29; 95% CI, 1.21-1.37) 24 and in patients with reduced levels of proteinemia (OR, 2.01; 95% CI, 1.03-3.94), 31 increased levels of partial arterial carbon dioxide pressure (PCO 2 ) (OR, 1.02; 95% CI, 1.00-1.05), 31 or C-reactive protein (Z7.6 mg/L; OR, 7.41; 95% CI, 1.34-40.91), 30 all measured in the predischarge or the discharge phase. Surprisingly, in a retrospective study of a very large cohort of COPD patients, 24 obesity played a protective role (OR, 0.87; 95% CI, 0.84-0.91) in readmission due to all causes.…”

“…Sex was also identified in 3 of these studies, [24][25][26] although with contrasting results. A Chinese 25 retrospective study evaluating all readmissions to the hospital in COPD patients found that male sex was associated with an increased risk of readmission (OR, 1.45; 95% CI, 1.38-1.52); a protective role in comparison with the other sex was tested in 2 retrospective studies 24,26 for all readmitted COPD patients, showing a reduced risk of readmission in men 24 (OR, 0.75; 95% CI, 0.72-0.77) and women 26 (OR, 0.9; 95% CI, 0.7-0.9).…”

“…With regard to general patient characteristics that predict readmission, age has been considered as a significant factor in only 1 retrospective study, 24 but without a clear positive or negative power [odds ratio (OR), 1.00; 95% confidence interval (CI), 1.00-1.00]. Sex was also identified in 3 of these studies, [24][25][26] although with contrasting results.…”

“…In terms of comorbidities associated with COPD, the presence of cancer, 24,26,29 heart failure, 24-26 coronary disease, 32 chronic cor pulmonale, 31 diabetes, 29,30 moderate or severe liver disease, 29 osteoporosis, 26 anxiety 26 or depression, 26 unilateral pulmonary infiltrates, 32 and the number of comorbidities in general, defined by the Charlson index 24,28 (Table 1), play a unanimously negative role in favoring readmission to the hospital. A similar role has been found in patients suffering from malnutrition (OR, 1.29; 95% CI, 1.21-1.37) 24 and in patients with reduced levels of proteinemia (OR, 2.01; 95% CI, 1.03-3.94), 31 increased levels of partial arterial carbon dioxide pressure (PCO 2 ) (OR, 1.02; 95% CI, 1.00-1.05), 31 or C-reactive protein (Z7.6 mg/L; OR, 7.41; 95% CI, 1.34-40.91), 30 all measured in the predischarge or the discharge phase.…”

Reducing the Readmission Burden of COPD: A Focused Review of Recent Interventions

“…Malnutrition is correlated with increased risk of 30-day readmission rate, even when controlling for confounders. Interestingly, obesity affords a modest protective impact on readmission [30]. Poor adherence to treatment and followup has recently been implicated as an independent predictor of increased readmission rate [29].…”