Bernardes Simone, Teixeira Paulo José Zimermann, Silva Flávia Moraes
Health Sciences Graduate Program from Federal University of Health Sciences of Porto Alegre, RS, Brazil.
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.
JPEN J Parenter Enteral Nutr. 2023 Jan;47(1):101-108. doi: 10.1002/jpen.2390. Epub 2022 May 28.
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.
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.
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.
BMI was inaccurate in identifying malnutrition in hospitalized patients with AECOPD and was associated with hospital stays longer than ten days.
体重指数（BMI）在慢性阻塞性肺疾病（COPD）中具有预后价值，尽管其在识别营养不良方面存在局限性，但仍常用于评估营养状况。我们旨在证实BMI与慢性阻塞性肺疾病急性加重（AECOPD）患者住院结局之间的关联及其在诊断营养不良方面的不准确性。
我们使用主观全面评定法（SGA）、营养与饮食学会-美国肠外肠内营养学会（AND-ASPEN）以及两个降低的BMI临界值（年龄相关和≤21.0）来诊断营养不良。以SGA和AND-ASPEN作为参考，使用受试者工作特征曲线下面积（AUC-ROC）评估BMI的准确性。我们评估了住院死亡率和住院时间结局，并构建了逻辑回归模型。
中位住院时间为11（7-18）天，7.5%的患者死亡。根据BMI、SGA和AND-ASPEN评估的营养不良患病率分别为21.4%（两个临界值的平均值）、50%和54%。降低的BMI与营养不良诊断的参考方法一致性较低（κ=0.315-0.383）且准确性不佳（AUC-ROC曲线=0.333-0.679）。在调整模型中，年龄相关的降低BMI（比值比[OR]=2.11；95%可信区间，1.10-4.04）和BMI≤21.0（OR=2.25；95%可信区间，1.13-4.48）与住院时间长于中位数相关，但与住院死亡率无关。
BMI在识别AECOPD住院患者的营养不良方面不准确，且与住院时间超过十天相关。
