It’s more than low BMI: prevalence of cachexia and associated mortality in COPD

Respiratory Research

Alvar Agusti¹  Richard Casaburi²  Stephen I. Rennard³  Bartolome Celli⁴  Edwin K. Silverman⁵  Craig P. Hersh⁵  Emiel F. M. Wouters⁶  Erica Rutten⁶  Marcas Bamman⁷  Mark Dransfield⁸  Merry-Lynn N. McDonald⁹  David A. Lomas^1,10  Ruth Tal-Singer^1,11 

[1] 0000 0000 9314 1427, grid.413448.e, Fundació Investigació Sanitària Illes Balears (FISIB), Ciber Enfermedades Respiratorias (CIBERES), Barcelona, Catalunya, Spain;0000 0004 1937 0247, grid.5841.8, Thorax Institute, Hospital Clinic, IDIBAPS, Univ. Barcelona, Barcelona, Spain;0000 0000 9632 6718, grid.19006.3e, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor Harbor-UCLA Medical Center, Torrance, CA, USA;0000 0001 0666 4105, grid.266813.8, Department of Medicine, Nebraska Medical Center, Omaha, NE, USA;0000 0004 5929 4381, grid.417815.e, Biopharma R&D, AstraZeneca, Cambridge, UK;0000 0004 0378 8294, grid.62560.37, Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA;0000 0004 0378 8294, grid.62560.37, Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA;0000 0004 0378 8294, grid.62560.37, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA;0000 0004 0480 1382, grid.412966.e, Centre of expertise for chronic organ failure, Horn, the Netherlands and Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands;0000000106344187, grid.265892.2, Center for Exercise Medicine and Departments of Cell, Developmental & Integrative Biology; Medicine; and Neurology, University of Alabama at Birmingham, Birmingham, AL, USA;0000000106344187, grid.265892.2, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;0000000106344187, grid.265892.2, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;0000000106344187, grid.265892.2, Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA;0000000106344187, grid.265892.2, Lung Health Center, University of Alabama at Birmingham, 701 19th Street S, LHRB 440, 35233, Birmingham, AL, USA;0000000106344187, grid.265892.2, Center for Exercise Medicine, University of Alabama at Birmingham, 701 19th Street S, LHRB 440, 35233, Birmingham, AL, USA;0000000121901201, grid.83440.3b, UCL Respiratory, University College London, London, UK;GSK R&D, Collegeville, PA, USA;

关键词: COPD;    Cachexia;    BODE;    Weight loss;    BMI;   

DOI  :  10.1186/s12931-019-1073-3

来源: publisher

【 摘 要 】

BackgroundCachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients. However, low body mass index (BMI) as opposed to cachexia is often used, particularly when calculating the BODE (BMI, Obstruction, Dyspnea and Exercise) index. For this reason, we examined mortality using a consensus definition and a weight-loss definition of cachexia among COPD cases and compared two new COPD severity indices with BODE.MethodsIn the current report, the consensus definition for cachexia incorporated weight-loss > 5% in 12-months or low BMI in addition to 3/5 of decreased muscle strength, fatigue, anorexia, low FFMI and inflammation. The weight-loss definition incorporated weight-loss > 5% or weight-loss > 2% (if low BMI) in 12-months. The low BMI component in BODE was replaced with the consensus definition to create the CODE (Consensus cachexia, Obstruction, Dyspnea and Exercise) index and the weight-loss definition to create the WODE (Weight loss, Obstruction, Dyspnea and Exercise) index. Mortality was assessed using Kaplan-Meier survival and Cox Regression. Performance of models was compared using C-statistics.ResultsAmong 1483 COPD cases, the prevalences of cachexia by the consensus and weight-loss definitions were 4.7 and 10.4%, respectively. Cachectic patients had a greater than three-fold increased mortality by either the consensus or the weight-loss definition of cachexia independent of BMI and lung function. The CODE index predicted mortality slightly more accurately than the BODE and WODE indices.ConclusionsCachexia is associated with increased mortality among COPD patients. Monitoring cachexia using weight-loss criteria is relatively simple and predictive of mortality among COPD cases who may be missed if only low BMI is used.

【 授权许可】

CC BY