Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study

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.

A Diagnostic Nomogram for Predicting Hypercapnic Respiratory Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…29 Malnutrition lowers muscle mass and impairs respiratory muscle function, which can exacerbate airflow limitation and increase the risk of respiratory failure in patients with AECOPD. 10 Second, PNI calculation relies on circulating lymphocytes and is affected by viral infection and the immune function status during virus infection. 30 Several studies have found that individuals with infection-related disorders such as COPD, 30 sepsis, 31 and bacteremia 32 have a worse prognosis when their circulating lymphatic count is low.…”

“… 29 Malnutrition lowers muscle mass and impairs respiratory muscle function, which can exacerbate airflow limitation and increase the risk of respiratory failure in patients with AECOPD. 10 …”

“…A meta-analysis including 13 articles revealed that the incidence of type II respiratory failure in AECOPD patients was negatively correlated with protein and uric acid values. 9 Zhao et al 10 found a negative correlation between the sarcopenia index (SI) and respiratory failure in AECOPD patients. Chen et al 11 determined seven predictors using the Least Absolute Shrinkage and Selection Operator (LASSO) regression and used these predictors to create a nomogram that could be utilized to predict the mortality risk in AECOPD patients with HRF.…”

Association Between Sarcopenia and Chronic Renal Failure (Overt and Concealed) in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Cross-Sectional Study

“…Chronic conditions like COPD are often linked to sarcopenia, a syndrome marked by a gradual loss in skeletal muscle mass, strength, and function [1]. Airflow restriction and comorbidities are common features of the chronic respiratory disease COPD [2]. With considerable overlap in clinical characteristics and therapies, sarcopenia and COPD are increasingly recognized as related [1].…”

“…Several clinical outcomes, including exercise capacity, balance, strength, gait speed, physical activity levels, and health-related quality of life, have been shown to deteriorate when sarcopenia is present in COPD patients. Exacerbations of COPD can also lead to a rapid decrease in muscle mass and functionality [2]. Therefore, understanding the relationship between sarcopenia and COPD is essential for monitoring and treating COPD patients effectively.…”