El Labban Mohamad, El-Zibaoui Roba, Usama Syed Muhammad, Niaz Fayreal, Cohen Abbe, Krastev Peter, Khan Syed, Surani Salim
Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
School of Medicine, American University of Beirut, Beirut, Lebanon.
Open Respir Med J. 2024 Aug 23;18:e18743064322829. doi: 10.2174/0118743064322829240801094830. eCollection 2024.
The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes.
This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE.
Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis.
The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 . 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% . 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% . 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge.
Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.
肥胖悖论表明，患有慢性阻塞性肺疾病急性加重（COPDE）的肥胖患者可能有更好的预后。慢性阻塞性肺疾病患者营养不良的风险更高，这与不良预后有关。
本文旨在研究营养不良对因COPDE住院的肥胖和非肥胖患者的影响。
我们的回顾性研究分析了2017年至2020年国家住院样本数据集的数据，以观察因COPDE住院的患者。患者分为两组：有营养不良和无营养不良。结局指标包括全因死亡率、有创机械通气、住院时间和总费用。我们使用多变量回归模型分析对混杂因素进行了调整。
该研究纳入了392920例COPDE患者，其中5720例（1.45%）被诊断为营养不良。两组中的大多数患者为女性、白人且有医疗保险覆盖。营养不良患者的平均年龄更高（67.6岁对64岁）。与三年前相比，两组在2020年的入院率均最低。营养不良患者的全因死亡率发生率和调整后的比值比更高（3.59%对0.61%，P<0.01；调整后的比值比（aOR）为2.36，P<0.01，可信区间1.8 - 3.7）。在使用有创机械通气时，我们观察到了类似的结果（13.2%对2.82%，P<0.01，aOR为4.9，P<0.01，3.9 - 6）。营养不良患者的住院时间更长，总费用更高。
营养不良被确定为因慢性阻塞性肺疾病急性加重入院的肥胖患者预后较差的独立危险因素。
