Master's Student in the Nutrition Science Postgraduate Program, Federal University of Health Sciences, Porto Alegre, RS, Brazil.
Federal University of Health Sciences of Porto Alegre, RS, Brazil.
Clin Nutr ESPEN. 2021 Apr;42:188-194. doi: 10.1016/j.clnesp.2021.01.042. Epub 2021 Feb 10.
Besides pulmonary dysfunctions, patients with chronic obstructive pulmonary disease (COPD) also frequently have systemic comorbidities. Among these, sarcopenia is associated with worse pulmonary function and clinical outcomes. Patients with acute exacerbated COPD (AECOPD) have increased systemic inflammation, which can intensify muscle dysfunction. Therefore, the present study aimed to evaluate the prevalence of sarcopenia in AECOPD patients and assess the associated factors and their prognostic value. As a secondary aim, we also assessed the performance of calf circumference (CC) to diagnose this condition.
Prospective cohort study in a Brazilian public hospital with AECOPD patients. Sarcopenia was assessed according to the recommendations from the European Working Group of Sarcopenia in Older People Consensus 2 (EWGSOP2); namely, reduced handgrip strength (HGS) combined with low fat-free mass index (FFMI) or CC. Data on clinical, nutritional, and sociodemographic features were collected. The evaluated clinical outcomes were the length of hospital stay (LOS), admission in intensive care units (ICUs), and in-hospital death.
Among 208 patients (54.8% females, 67.6 ± 10.1 years) evaluated, 16.3% presented sarcopenia. Malnutrition (odds ratio [OR] = 16.50, 95% confidence interval [CI] 3.58-76.08), and disease stages III-IV (OR = 4.05 95%CI 1.20-13.76) were associated with the presence of sarcopenia. The CC showed satisfactory performance in diagnosing sarcopenia as compared to FFMI as a marker of reduced muscle mass (kappa = 0.703; area under the receiver operating characteristic [AUC ROC] curve = 0.886; 95%CI 0.811-0.961). Sarcopenia was not associated with clinical outcomes.
Almost 20% of patients in this study presented sarcopenia. Malnutrition and advanced Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage were associated with increased chances of this condition in AECOPD patients. Reduced HSG combined with low CC may be an alternative when FFMI not be obtained for sarcopenia diagnosis.
除了肺部功能障碍外，慢性阻塞性肺疾病（COPD）患者还常伴有全身性合并症。其中，肌肉减少症与更差的肺功能和临床结局相关。患有急性加重期 COPD（AECOPD）的患者全身炎症增加，这可能会加剧肌肉功能障碍。因此，本研究旨在评估 AECOPD 患者中肌肉减少症的患病率，并评估相关因素及其预后价值。作为次要目标，我们还评估了小腿围（CC）用于诊断该疾病的性能。
这是一项在巴西公立医院进行的前瞻性队列研究，纳入 AECOPD 患者。根据欧洲老年人肌肉减少症工作组共识 2（EWGSOP2）的建议评估肌肉减少症；即，握力（HGS）降低结合低去脂体重指数（FFMI）或 CC。收集临床、营养和社会人口统计学特征的数据。评估的临床结局包括住院时间（LOS）、入住重症监护病房（ICU）和院内死亡。
在评估的 208 名患者（54.8%为女性，67.6±10.1 岁）中，16.3%存在肌肉减少症。营养不良（比值比[OR] = 16.50，95%置信区间[CI] 3.58-76.08）和疾病分期 III-IV（OR = 4.05，95%CI 1.20-13.76）与肌肉减少症的存在相关。与 FFMI 作为肌肉减少的标志物相比，CC 对肌肉减少症的诊断具有较好的性能（kappa = 0.703；接受者操作特征曲线下面积[AUROC] = 0.886；95%CI 0.811-0.961）。肌肉减少症与临床结局无关。
本研究中近 20%的患者存在肌肉减少症。营养不良和较高的全球慢性阻塞性肺疾病倡议（GOLD）分期与 AECOPD 患者中该疾病的发生几率增加相关。当无法获得 FFMI 进行肌肉减少症诊断时，降低 HGS 结合低 CC 可能是一种替代方法。
